COMMENTARY

The Emerging Epidemic of Nonalcoholic Fatty Liver Disease

Rowen K. Zetterman, MD

Disclosures

January 21, 2011

In This Article

Therapy for NAFLD

The initial therapy for NAFLD should be directed at changes in lifestyle and the associated underlying conditions.[42,43,44] Weight reduction and exercise should be as starting points for those who are obese.[45] Clinical information suggests that a loss of 10% of body weight may have a significant effect on improvement of liver tests and of symptoms, such as right upper quadrant pain. For patients with glucose intolerance, blood sugar control is crucial. Hyperlipidemia can be treated with medications when needed. Currently, no specific dietary program can be recommended, although diets low in fat and carbohydrates and supplemented by probiotics may be appropriate.[46]

Current medications should be evaluated; if known to be associated with NAFLD, they should discontinued when possible. With suspected bacterial overgrowth of the small bowel, periodic administration of broad-spectrum antibiotics may be considered.

Pharmacologic therapy of NASH is limited and no specific therapy is currently approved for treatment. Although it seems intuitive that insulin-sensitizing agents should be effective, thiazolidinediones (glitazones) may only be partially effective[47,48] and metformin not at all.[49]Vitamin E seems to improve liver histology in patients who have NASH but not diabetes mellitus[50]; additional studies are needed. A preliminary trial of pentoxifylline improved aminotransferases and liver histology.[51]

For patients with morbid obesity, gastric bypass surgery can improve hepatic inflammation, steatosis, and fibrosis.[52] Orthotopic liver transplantation is used for those with end-stage disease, although recurrence of NASH posttransplantation is frequent.[53] Patients who undergo liver transplantation must closely control weight gain and hyperlipidemia.

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