Non-alcoholic fatty liver disease medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Weight loss and management of underlying insulin resistance/metabolic syndrome as well as withdrawal of hepatotoxic agents is the | 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== | ==Medical Therapy== | ||
There is no [[Food and Drug Administration|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. | |||
* | |||
* [[Rosiglitazone]] is recommended among all patients who develop NAFLD. Long term treatment with rosiglitazone in patients with NAFLD shows significant improvement.<ref name="urlLong-term efficacy of rosiglitazone in nonalcoholic steatohepatitis: Results of the fatty liver improvement by rosiglitazone therapy (FLIRT 2) extension trial - Ratziu - 2009 - Hepatology - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1002/hep.23270/pdf |title=Long-term efficacy of rosiglitazone in nonalcoholic steatohepatitis: Results of the fatty liver improvement by rosiglitazone therapy (FLIRT 2) extension trial - Ratziu - 2009 - Hepatology - Wiley Online Library |format= |work= |accessdate=}}</ref> | ==== Weight management ==== | ||
** Rosiglitazone 4 mg PO/OD | * 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. | ||
* Patients with NAFLD shows benifits when using [[ursodeoxycholic acid]] (UDCA) in combination with [[vitamin E]] | * 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]]. | ||
** Vitamin C 30 mg/Kg/PO/OD.<ref name="pmid1461350">{{cite journal |vauthors=Busciglio J, Lorenzo A, Yankner BA |title=Methodological variables in the assessment of beta amyloid neurotoxicity |journal=Neurobiol. Aging |volume=13 |issue=5 |pages=609–12 |year=1992 |pmid=1461350 |doi= |url=}}</ref> | ** '''Preferred regimen''' : [[Orlistat]] 120 mg PO q8h | ||
* Avoid high dose of vitamin E which increases the [[Fatality rate|fatality]] rate. | |||
==== Management of hyperlipidemia ==== | |||
* The direct effect of anti-lipd agents on NAFLD and liver histology has not been clearly shown in studies. | |||
* [[Statin|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.<ref name="urlLong-term efficacy of rosiglitazone in nonalcoholic steatohepatitis: Results of the fatty liver improvement by rosiglitazone therapy (FLIRT 2) extension trial - Ratziu - 2009 - Hepatology - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1002/hep.23270/pdf |title=Long-term efficacy of rosiglitazone in nonalcoholic steatohepatitis: Results of the fatty liver improvement by rosiglitazone therapy (FLIRT 2) extension trial - Ratziu - 2009 - Hepatology - Wiley Online Library |format= |work= |accessdate=}}</ref> | |||
** '''Preferred regimen''' : [[Rosiglitazone]] 4 mg PO/OD q24h .<ref name="pmid21430606">{{cite journal |vauthors=Saryusz-Wolska M, Szymańska-Garbacz E, Jabłkowski M, Białkowska J, Pawłowski M, Kwiecińska E, Omulecka A, Borkowska A, Ignaczak A, Loba J, Czupryniak L |title=Rosiglitazone treatment in nondiabetic subjects with nonalcoholic fatty liver disease |journal=Pol. Arch. Med. Wewn. |volume=121 |issue=3 |pages=61–6 |year=2011 |pmid=21430606 |doi= |url=}}</ref> | |||
==== 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]] <ref name="pmid17162245">{{cite journal |vauthors=Dufour JF, Oneta CM, Gonvers JJ, Bihl F, Cerny A, Cereda JM, Zala JF, Helbling B, Steuerwald M, Zimmermann A |title=Randomized placebo-controlled trial of ursodeoxycholic acid with vitamin e in nonalcoholic steatohepatitis |journal=Clin. Gastroenterol. Hepatol. |volume=4 |issue=12 |pages=1537–43 |year=2006 |pmid=17162245 |doi=10.1016/j.cgh.2006.09.025 |url=}}</ref> | |||
* [[vitamin E]] alone or in combination with [[vitamin C]] is also recommended in patients without any side effects in fibrosis score.<ref name="pmid14638353">{{cite journal |vauthors=Harrison SA, Torgerson S, Hayashi P, Ward J, Schenker S |title=Vitamin E and vitamin C treatment improves fibrosis in patients with nonalcoholic steatohepatitis |journal=Am. J. Gastroenterol. |volume=98 |issue=11 |pages=2485–90 |year=2003 |pmid=14638353 |doi=10.1111/j.1572-0241.2003.08699.x |url=}}</ref> | |||
** '''Preferred regimen (1) :''' [[Vitamin E]] 800 mg PO /OD.<ref name="pmid15537682">{{cite journal |vauthors=Miller ER, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E |title=Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality |journal=Ann. Intern. Med. |volume=142 |issue=1 |pages=37–46 |year=2005 |pmid=15537682 |doi= |url=}}</ref> | |||
** '''Preferred regimen (1) :''' [[Vitamin C]] 30 mg/Kg/PO/OD.<ref name="pmid1461350">{{cite journal |vauthors=Busciglio J, Lorenzo A, Yankner BA |title=Methodological variables in the assessment of beta amyloid neurotoxicity |journal=Neurobiol. Aging |volume=13 |issue=5 |pages=609–12 |year=1992 |pmid=1461350 |doi= |url=}}</ref> | |||
** '''Note:''' Avoid high dose of [[vitamin E]] which increases the [[Fatality rate|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.<ref name="urlpdfs.semanticscholar.org">{{cite web |url=https://pdfs.semanticscholar.org/3198/7b349e2bbce24f2cbcdd4c5a67d940b186b4.pdf |title=pdfs.semanticscholar.org |format= |work= |accessdate=}}</ref> | * ''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.<ref name="urlpdfs.semanticscholar.org">{{cite web |url=https://pdfs.semanticscholar.org/3198/7b349e2bbce24f2cbcdd4c5a67d940b186b4.pdf |title=pdfs.semanticscholar.org |format= |work= |accessdate=}}</ref> | ||
Revision as of 16:17, 22 December 2017
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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.[1]
- Preferred regimen : Rosiglitazone 4 mg PO/OD q24h .[2]
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 [3]
- vitamin E alone or in combination with vitamin C is also recommended in patients without any side effects in fibrosis score.[4]
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.[7]
References
- ↑ "Long-term efficacy of rosiglitazone in nonalcoholic steatohepatitis: Results of the fatty liver improvement by rosiglitazone therapy (FLIRT 2) extension trial - Ratziu - 2009 - Hepatology - Wiley Online Library".
- ↑ Saryusz-Wolska M, Szymańska-Garbacz E, Jabłkowski M, Białkowska J, Pawłowski M, Kwiecińska E, Omulecka A, Borkowska A, Ignaczak A, Loba J, Czupryniak L (2011). "Rosiglitazone treatment in nondiabetic subjects with nonalcoholic fatty liver disease". Pol. Arch. Med. Wewn. 121 (3): 61–6. PMID 21430606.
- ↑ Dufour JF, Oneta CM, Gonvers JJ, Bihl F, Cerny A, Cereda JM, Zala JF, Helbling B, Steuerwald M, Zimmermann A (2006). "Randomized placebo-controlled trial of ursodeoxycholic acid with vitamin e in nonalcoholic steatohepatitis". Clin. Gastroenterol. Hepatol. 4 (12): 1537–43. doi:10.1016/j.cgh.2006.09.025. PMID 17162245.
- ↑ Harrison SA, Torgerson S, Hayashi P, Ward J, Schenker S (2003). "Vitamin E and vitamin C treatment improves fibrosis in patients with nonalcoholic steatohepatitis". Am. J. Gastroenterol. 98 (11): 2485–90. doi:10.1111/j.1572-0241.2003.08699.x. PMID 14638353.
- ↑ Miller ER, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E (2005). "Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality". Ann. Intern. Med. 142 (1): 37–46. PMID 15537682.
- ↑ Busciglio J, Lorenzo A, Yankner BA (1992). "Methodological variables in the assessment of beta amyloid neurotoxicity". Neurobiol. Aging. 13 (5): 609–12. PMID 1461350.
- ↑ "pdfs.semanticscholar.org" (PDF).