Metformin in the treatment of non-alcoholic fatty liver disease: safety, efficacy and mechanism

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease etiology worldwide. It encompasses a spectrum ranging from simple steatosis to non-alcoholic steatohepatitis. Although the physiopathology of NAFLD is partly known. Insulin-resistance plays a central role in the development and progression of NAFLD. Several studies have indicated that metformin, as an insulin sensitizer, effectively improves NAFLD and its related metabolic status. Metformin was effective in reducing enzyme levels in the short period, but very limited and controversial information are available on liver histology. Larger randomized controlled trials of sufficient duration using clearly defined histological endpoints are needed to fully assess the efficacy of this drug in modifying the natural history of NAFLD.

Keywords::

• insulin resistance
• metformin
• non-alcoholic fatty liver disease
• non-alcoholic steatohepatitis
• steatosis

Acknowledgements

The authors are grateful to SH Price (John F Kennedy Memorial Hospital, Indio, CA, USA) for her assistance in medical literature search.

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

• Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide.

• The insulin resistance plays the central role in the development and progression of NAFLD.

• Metformin could have a beneficial role in the patients with NAFLD, improving liver biochemistry and metabolic syndrome features.

• Metformin also appears to be safe in mild liver disease.

• Metformin effect on liver histology remains controversial.

• Larger randomized controlled trials are needed to fully assess the efficacy of metformin in NAFLD.