title: Managing the combination of nonalcoholic fatty liver disease and metabolic syndrome.
abstract: BACKGROUND
  Metabolic syndrome (MetS) and nonalcoholic fatty liver disease (NAFLD) are part of the same metabolic defect, both having insulin resistance as the main pathogenic mechanism and sharing similar outcomes (i.e., cardiovascular and liver-related mortality). The prevalence of NAFLD is expected to rise, owing to the increasing worldwide prevalence of obesity and MetS; therefore, the identification of factors responsible for disease progression is essential to devise therapeutic strategies.
  
  
  METHODS
  The available and potential future treatments for NAFLD in combination with MetS are reviewed in this paper, following an extensive literature search and personal experience.
  
  
  CONCLUSIONS
  All NAFLD patients should be evaluated for their metabolic, cardiovascular and liver-related risk. Weight loss through lifestyle intervention remains the most comprehensive and safe treatment of NAFLD and associated MetS; however, > 50% of patients fail to achieve target weight loss. Pharmacologic treatment seems to be important for these patients and for NAFLD cases with more advanced liver disease. It temporarily reverses metabolic alterations, but liver disease progresses after the treatment is stopped. Although current treatments are unsatisfactory, new drugs have been proposed and a few innovative compounds are in the pipeline of pharmaceutical companies. Before pharmacologic treatment can be routinely recommended for NAFLD, long-term randomized trials are needed, along with assessments of the safety and benefits of drugs on proper histological outcomes or validated surrogate markers. The intensive control of individual features of MetS remains mandatory.
authors: University of Bologna, Alma Mater Studiorum, Unit of Metabolic Diseases & Clinical Dietetics, Policlinico S. Orsola, Via Massarenti, 9, 40138 Bologna, Italy.
authors: Simona
authors: S
authors: Moscatiello
authors: Raffaella
authors: R
authors: Di Luzio
authors: Anna Simona
authors: AS
authors: Sasdelli
authors: Giulio
authors: G
authors: Marchesini
mesh_terms: D000818:Animals; D005234:Fatty Liver / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance; D008019:Life Style; D024821:Metabolic Syndrome / Q000628:therapy*; D065626:Non-alcoholic Fatty Liver Disease; D015431:Weight Loss
chemical_list: D007004:Hypoglycemic Agents