Current management of patients with nonalcoholic fatty liver disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) and its progressive form, nonalcoholic steatohepatitis (NASH) are the most common causes of chronic liver disease in industrialized countries. NAFLD has also been strongly associated with type II diabetes and cardiovascular diseases. This study was a multipurposed review, which included discussion of recent studies investigating the cellular and genetic basis of these diseases, the pathogenesis of NAFLD and the current treatment and management of nonalcoholic steatohepatitis. Currently, maintaining a healthy weight through dietary changes and exercise, the use of insulin-modulating pharmacologic agents for diabetes control and the use of lipid-lowering, anti-oxidants have been the most widely recommended treatments. Inclusion of pathogenic mechanisms in treatment design will allow future therapies to target-specific pathways involved in NAFLD pathogenesis.

Keywords::

• CVD
• diabetes mellitus
• insulin sensitivity
• medical and surgical treatment interventions
• NAFLD
• NASH
• obesity
• weight loss

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Nonalcoholic fatty liver disease (NAFLD) and its more severe form NASH are common liver diseases in industrialized countries.

• • Diabetes, obesity, the metabolic syndrome and NAFLD all share common pathogenic mechanisms.

• • Cardiovascular disease (CVD) is the most common cause of death in NAFLD patients.

• • Liver biopsy and noninvasive markers should be used to stage and grade nonalcoholic steatohepatitis (NASH) in patients.

• • Though liver biopsy remains the ‘suboptimal’ gold standard for diagnosis of NASH and staging of fibrosis is essential but not sufficient.

• • Most treatment approaches focus on alleviating the metabolic effects of insulin resistance (IR) because IR appears to be the key underlying abnormality in NAFLD.

• • Nonpharmacologic modalities for treating NAFLD, such as weight loss, aim to improve IR.

• • The pharmacologic agents used in treating NAFLD include insulin-modulating, lipid-modulating, fibrosis-modulating and oxidative stress-modulating therapies.

• • At present, Vitamin E can be recommended to nondiabetics with NASH.

• • Bariatric surgery has shown some promise in selected individuals in reducing the NAFLD-induced inflammation and improving cellular histology.

• • Successful treatment will need to include genetic or molecular-level interventions using the new technologies of genomics, proteomics and biomarker discovery.

• • There is a need for novel medical management, which is capable of controlling the adverse impact of NAFLD on CVD risk to improve clinical outcomes of these patients.