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Current treatments of NAFLD/ NASH target the effective treatment of metabolic drivers and/or co-morbidities such as insulin resistance, obesity and diabetes mellitus.
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Multidisciplinary teams and approach to managing patients with NAFLD/NASH may optimize success with behavioral and life-style modification.
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Alcohol use, even in small amounts, should be avoided in patients with NASH and fibrosis due to risk of accelerating fibrosis progression.
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Although there are currently no FDA approved drugs for
Current Treatment Options, Including Diet, Exercise, and Medications: The Impact on Histology
Section snippets
Key points
Multidisciplinary lifestyle intervention in nonalcoholic steatohepatitis
The lack of pharmacologic interventions for NASH makes lifestyle measures exceedingly important. Long-term adoption of these measures; however, is challenging. Improve dietary composition independent of weight loss may improve NASH. Weight loss of 5-10% of the initial body weight and moderate increases in physical activity can also improve the histologic features of NAFLD/NASH.
Lifestyle modification with a healthy diet and routine physical activity is the foundation of treatment not only for
Role of macronutrient composition
Changes in dietary composition (eg, low carbohydrate vs low-fat diet, intermittent fasting, Mediterranean diet, etc.) and different intensities of caloric restriction appear comparable and their ability to improve NAFLD and NASH.34 A Mediterranean diet is often recommended for patients with NAFLD/NASH based on its demonstrable reduction and liver fat35,36 while also lending cardiovascular benefits.37 Intermittent calorie restriction (the 5:2 diet) and a low-carb high-fat diet (LCHF) were
Repurposed medications for nonalcoholic fatty liver disease/steatohepatitis
Although there are currently no US Food and Drug Administration (FDA)-approved drugs for the treatment of NASH at any disease stage, medications approved for commonly associated comorbidities such as T2DM and obesity have been shown to reduce liver enzymes, steatosis, and histology features of steatohepatitis. Therefore, early intervention with medications approved for treatment of complications of metabolic syndrome may be considered in patients with NAFLD/NASH (Table 1).
Summary
Although liver-directed pharmacology therapy for the treatment of NAFLD/NASH does not currently exist, treatment options inclusive of dietary modification, increased physical activity, and effectively managing complications of metabolic syndrome including obesity, diabetes, and/or dyslipidemia have the potential to improve the histologic feature of NASH. Efficacy data are available to support the use of pioglitazone and vitamin E in NASH and data are emerging regarding the role of GLP-1
Clinics care points
In patients with NASH, the goal of treatment is to reverse steatohepatitis and fibrosis, or at least halt fibrosis progression by directing early interevention at reversing the unfavorable metabolic profile. Successful interevention favors a multidisciplinary team including primary care, nutrition/dietician, behavioral therapists, endocrinologists and gastroenterologist/hepatologist in a patient tailored approach. When considering treatment for diabetes, preference should be lent to those
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