title: Nonalcoholic steatohepatitis: emerging targeted therapies to optimize treatment options.
abstract: Diet and lifestyle changes have led to worldwide increases in the prevalences of obesity and metabolic syndrome, resulting in substantially greater incidence of nonalcoholic fatty liver disease (NAFLD). NAFLD is considered a hepatic manifestation of metabolic syndrome and is related to diabetes, insulin resistance, central obesity, hyperlipidemia, and hypertension. Nonalcoholic steatohepatitis (NASH) is an entity that describes liver inflammation due to NAFLD. Growing evidence suggests that NAFLD is a multisystem disease with a clinical burden that is not only confined to liver-related morbidity and mortality, but that also affects several extra-hepatic organs and regulatory pathways. Thus, NAFLD is considered an important public health issue, but there is currently no effective therapy for all NAFLD patients in the general population. Studies seeking optimal therapy for NAFLD and NASH have not yet led to development of a universal protocol for treating this growing problem. Several pharmacological agents have been studied in an effort to improve insulin resistance and the proinflammatory mediators that may be responsible for NASH progression. Cardiovascular risk factors are highly prevalent among NASH patients, and the backbone of treatment regimens for these patients still comprises general lifestyle interventions, including dietary changes and increased physical activity. Vitamin E and thiazolidinedione derivatives are currently the most evidence-based therapeutic options, but only limited clinical evidence is available regarding their long-term efficacy and safety. Vitamin D and renin-angiotensin-aldosterone system blockers are promising drugs that are currently being intensively investigated for use in NAFLD/NASH patients.
authors: Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia.
authors: Sandra
authors: S
authors: Milic
authors: Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia ; Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, Rijeka, Croatia.
authors: Ivana
authors: I
authors: Mikolasevic
authors: Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia.
authors: Irena
authors: I
authors: Krznaric-Zrnic
authors: Department of Hematology, UHC Rijeka, Rijeka, Croatia.
authors: Marija
authors: M
authors: Stanic
authors: Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia.
authors: Goran
authors: G
authors: Poropat
authors: Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia.
authors: Davor
authors: D
authors: Stimac
authors: Department for Clinical Pharmacology, University of Rijeka Medical School, UHC Rijeka, Rijeka, Croatia.
authors: Vera
authors: V
authors: Vlahovic-Palcevski
authors: Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, Rijeka, Croatia.
authors: Lidija
authors: L
authors: Orlic
mesh_terms: D000465:Algorithms; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000818:Animals; D019091:Critical Pathways; D003661:Decision Support Techniques; D006801:Humans; D015994:Incidence; D008019:Life Style; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D015995:Prevalence; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors; D040242:Risk Reduction Behavior; D045162:Thiazolidinediones / Q000627:therapeutic use*; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D045162:Thiazolidinediones; D014807:Vitamin D
keywords: insulin resistance; metabolic syndrome; nonalcoholic fatty liver disease; therapy