SAN FRANCISCO — With no specific treatment available for nonalcoholic fatty liver disease, the best current strategy centers on monitoring the patient's condition and managing the patient's lifestyle and metabolic syndrome, Dr. Nathan M. Bass said at the Third World Congress on Insulin Resistance Syndrome.
The patient's liver enzymes, liver function (bilirubin levels, albumin levels, and prothrombin time), and platelet count should be monitored. Each patient also should undergo regular ultrasound exams.
Patients with nonalcoholic fatty liver disease (NAFLD) should be instructed to avoid hepatotoxins—especially alcohol—and should be advised to pursue gradual weight loss with diet and exercise.
“Weight loss remains the simplest advice you can give,” said Dr. Bass of the University of California, San Francisco. He pointed to a study showing that even modest weight loss (less than 10% of the patient's initial body weight) can reduce intrahepatic fat while leaving intramuscular fat unchanged. This level of weight loss also improved basal and insulin-stimulated glucose metabolism (Diabetes 2005;54:603–8).
Bariatric surgery can be helpful for some patients with NAFLD, but it should be the newer restrictive surgery that involves gastric banding; this approach tends to decrease steatosis, fibrosis, and nonalcoholic steatohepatitis. The older malabsorptive surgical strategies can be dangerous; they can lead to increased steatosis, fibrosis, nonalcoholic steatohepatitis, and liver failure.
The insulin-sensitizing agent metformin appears to be helpful in patients with NAFLD; however, the published studies tend to be small and open label, and thus the available evidence base is not overwhelming.
The thiazolidinedionespioglitazone and troglitazone appear to improve liver enzymes and fibrosis measured histologically, but once again, the evidence comes from open-label trials.
Dr. Bass noted some caveats to be observed regardingthiazolidinediones: They can cause weight gain and relapse upon discontinuation, and some patients experience serious side effects, such as heart failure and hepatotoxicity.