title: Nonalcoholic fatty liver disease: new treatments.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease is the most common cause of liver dysfunction in the western world because of its close association with obesity, insulin resistance and dyslipidaemia. Nonalcoholic steatohepatitis (NASH) is a particular health concern due to the increased morbidity and mortality associated with progressive disease. At present, without specific targeted pharmacological therapies, the mainstay of therapy remains weight loss through dietary modification and lifestyle change; thus, the purpose of this review is to summarize the recent evidence for current and emerging therapies in NASH.
  
  
  RESULTS
  Some existing medications, including pioglitazones and angiotensin receptor antagonists, may be repurposed to help treat this condition. Vitamin E may improve histology in NASH, but safety issues limit its use. Recently, a number of novel agents specifically targeting nonalcoholic fatty liver disease pathogenesis have entered clinical trials, including the farnesoid X receptor agonist obeticholic acid, which has shown significant histological improvements in steatohepatitis and fibrosis.
  
  
  CONCLUSIONS
  Diet/lifestyle modification remains the mainstay of treatment. For patients with NASH and advanced fibrosis, current liver-directed pharmacotherapy with vitamin E and pioglitazone offer some benefits; obeticholic acid appears promising and is currently being tested. Comorbidities must be diagnosed and treated; cardiovascular disease remains a primary cause of death in these patients.
authors.affiliation: Liver Research Group, Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle-Upon-Tyne, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Hardy
authors.forename: Quentin M
authors.initials: QM
authors.lastname: Anstee
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Day
mesh_terms: D000975:Antioxidants / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D050171:Dyslipidemias / Q000175:diagnosis / Q000178:diet therapy / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000178:diet therapy / Q000188:drug therapy*; D009765:Obesity / Q000150:complications / Q000517:prevention & control*; D000077205:Pioglitazone; D040242:Risk Reduction Behavior; D045162:Thiazolidinediones / Q000627:therapeutic use; D014810:Vitamin E / Q000627:therapeutic use; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D000975:Antioxidants; D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D014810:Vitamin E; D000077205:Pioglitazone