Non-alcoholic fatty liver disease medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Weight loss and management of underlying insulin resistance/metabolic syndrome as well as withdrawal of hepatotoxic agents is the mainstay of treatment in NAFLD.

Medical Therapy

There is no FDA approved specific treatment for NAFLD. Weight loss and management of underlying insulin resistance/metabolic syndrome as well as withdrawal of hepatotoxic agents is the mainstay of treatment in NAFLD.

Weight management

• Lifestyle modifications to achieve weight loss is a central aspect of management of NAFLD in obese patients and should include caloric restriction, reduction in saturated fat intake, and regular exercise.
• At present time there is no pharmacological agent that produces safe weight loss resulting in regression of steato-hepatitis and fibrosis. However, orlistat is an FDA approved drug regimen for safe weight loss.

• Weight reduction can help to reduce levels of liver enzymes, insulin.
  • Preferred regimen : Orlistat 120 mg PO q8h

Management of hyperlipidemia

• The direct effect of anti-lipd agents on NAFLD and liver histology has not been clearly shown in studies.
• Statins are the drugs of choice, however statins should not be administered as primary treatment of NAFLD, but rather as treatment of hyperlipidemia.
• The goal is to get the LDL down to < 100 mg/dl.
  • Preferred regimen: Atorvastatin 40 mg PO q24h

Management of Insulin resistance

• Rosiglitazone is recommended among all patients who develop NAFLD.
• Long term treatment with rosiglitazone in patients with NAFLD shows significant improvement.
  • Preferred regimen : Rosiglitazone 4 mg PO/OD q24h .

Anti-oxidants

• Antioxidants offer hepatocyte protection from free radical damage.

• Patients with NAFLD shows benifits when using ursodeoxycholic acid (UDCA) in combination with vitamin E
• vitamin E alone or in combination with vitamin C is also recommended in patients without any side effects in fibrosis score.
  • Preferred regimen (1) : Vitamin E 800 mg PO /OD.
  • Preferred regimen (1) : Vitamin C 30 mg/Kg/PO/OD.
  • Note: Avoid high dose of vitamin E which increases the fatality rate.

Miscellaneous

• Moringa Oleifera (MO), a plant from the family Moringacea is a major crop in Asia and Africa, the leaves of these plant have been studied extensively and it has shown to be beneficial in NAFLD and in prevention and alleviation of NAFLD.