Management of non-alcoholic fatty liver disease

ABSTRACT Non-alcoholic fatty liver disease is a very common medical condition, driven by combination of genetic and lifestyle factors, ultimately producing severe chronic increased cardiovascular risk. Most people are asymptomatic for long time, their daily life unaffected, leading to difficulty in identifying managing who slowly progress non-alcoholic steatohepatitis (NASH), NASH-cirrhosis, eventually hepatocellular carcinoma. Despite advances the understanding pathogenic mechanisms identification fibrosis as strongest factor predicting progression, no specific treatments have been approved regulatory agencies. Outside controlled trials, treatment generally limited intervention aimed at weight loss. Pioglitazone remains drug choice reduce progression with diabetes, although it often used off-label absence diabetes. Vitamin E mainly children may be considered adults without Several drugs under investigation according agreed targets reduced NASH activity worsening or improving NASH. Anti-inflammatory, anti-fibrotic agents metabolism modulators tested either phase III IIb randomized trials; few failed, others produced marginally positive results, but only being extension studies. The development non-invasive, easily repeatable surrogate biomarkers and/or imaging tools crucial facilitate clinical studies limit biopsy.