Treatment options for nonalcoholic fatty liver disease

Shivakumar Chitturi

Australian National University Medical School, Gastroenterology and Hepatology Unit, Canberra Hospital, Australian Capital Territory, Australia, shiv.chitturi@act.gov.au

Nonalcoholic fatty liver disease comprises a range of disorders from steatosis and steatohepatitis through to cirrhosis. Nonalcoholic steatohepatitis can progress to cirrhosis and liver-related death. Therefore, managing this common disorder is becoming an important public health issue. Lifestyle measures are commonly suggested but robust data are lacking. Trials with antioxidants (vitamin E, betaine) as well as cytoprotectants (ursodeoxycholic acid) have been disappointing. While data for insulin sensitizers such as metformin are less conclusive, thiazolidinediones appear promising. However, not all patients respond to thiazolidinediones. Moreover, issues related to weight gain, cardiovascular risk need to be addressed. The use of endocannabinoid antagonists and insulin secretagogues are novel strategies to combat this disorder.

Key Words: fatty liver • insulin sensitizers • nonalcoholic steatohepatitis • nonalcoholic fatty liver disease • endocannabinoids • thiazolidinediones • ursodeoxycholic acid • vitamin E • lifestyle intervention • physical activity