nonalcoholic%20fatty%20liver%20disease
NONALCOHOLIC FATTY LIVER DISEASE

Nonalcoholic fatty liver disease is having excessive fat (in the form of triglycerides) accumulation not due to excessive alcohol consumption or other secondary causes.

It is considered as a hepatic manifestation of metabolic syndrome.

Progression of nonalcoholic fatty liver disease is variable.

Principles of Therapy

  • Essential principle of therapy of nonalcoholic fatty liver disease (NAFLD) is to treat underlying cause
  • Goal of treatment is to improve insulin resistance & liver enzyme levels & decrease histologic features

Pharmacotherapy

  • Pharmacological therapy is indicated in patients with progressive nonalcoholic steatohepatitis (NASH) & in those in early stage of nonalcoholic steatohepatitis with increased risk of progressing to fibrosis (age >50 years, diabetes, metabolic syndrome, increased ALT or active nonalcoholic steatohepatitis with high necroinflammatory activity)
  • Pharmacologic treatments for nonalcoholic fatty liver/nonalcoholic steatohepatitis are targeted at underlying metabolic syndrome-related diseases such as obesity, type 2 diabetes mellitus, dyslipidemia & hypertension as well as liver dysfunction itself

Insulin Sensitizers

Thiazolidinediones (eg Pioglitazone)

  • Peroxisome proliferator-activated receptor agonists with insulin-sensitizing effects
  • Recommended for patients with insulin resistance
  • It was shown in clinical trials that Pioglitazone administered over a short duration have improved all histological features (except for fibrosis) & have resolution of nonalcoholic steatohepatitis (NASH) more often than the placebo
  • There is concern on side effects of Pioglitazone such as weight gain, bone fractures in women, & rarely congestive heart failure thus long-term treatment is not advisable

Incretin mimetics (eg Liraglutide)

  • Acts on glucose-insulin interplay & have shown favorable results in pre-marketing studies on liver enzymes
  • A small pilot trial of daily injections of Liraglutide met the histological outcome of nonalcoholic steatohepatitis remission without worsening fibrosis

Antioxidants, cytoprotective & lipid lowering agents

Vitamin E

  • A free radical scavenger & a chain-breaking antioxidant in free radical reactions such as lipid peroxidation
  • Studies have shown improvement in hepatic biological & histological parameters in patients with nonalcoholic steatohepatitis
  • Further studies are needed for Vitamin E to be used in non-cirrhotic, non-diabetic nonalcoholic steatohepatitis patients

Statins (eg Ezetimibe & HMG-CoA reductase)

  • May be used in patients with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis & hypercholesterolemia to prevent cardiovascular risk
  • In patients already taking statins, it is advised to continue with the medication & only consider stopping when liver enzyme levels double within 3 months of starting statins
Antihypertensives

Angiotensin II receptor antagonist (ARB)

  • Angiotensin II receptor antagonist is recommended in nonalcoholic steatohepatitis patients with hypertension
  • Inhibits fibroblast activity resulting in inhibition of tissue fibrosis in several organs

Other drugs

Pentoxifylline

  • Recommended in patients with nonalcoholic steatohepatitis
  • Considered to have both antioxidant & anti-TNF alpha effects
  • Clinical trials & meta-analyses found that Pentoxifylline improved serum biochemical indices & hepatic histological change
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 05 Oct 2017

Olfactory impairment in older adults may point to an elevated risk of developing Parkinson’s disease (PD), particularly in Caucasian men, a small US study found.

07 Oct 2017
Women who follow a low-fat dietary pattern appear to have reduced breast cancer mortality, according to data from the Earlier Women’s Health Initiative Dietary Modification trial.
Pearl Toh, 4 days ago
Women with higher plasma tryptophan concentrations were less likely to have poor sleep quality during pregnancy, especially among those with anxiety symptoms, according to the GUSTO* study.
6 days ago
Blood glucose testing every other day in patients with controlled gestational diabetes mellitus (GDM) resulted in higher testing compliance than every day testing, a new study has shown.