Non-alcoholic fatty liver disease medical therapy: Difference between revisions
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==== Management of hyperlipidemia ==== | ==== Management of hyperlipidemia ==== | ||
* The direct effect of anti- | * The direct effect of anti-lipid agents on NAFLD and liver histology has not been clearly understood. | ||
* [[Statin|Statins]] are the drugs of choice, however statins should not be administered as primary treatment of NAFLD, but rather as treatment of hyperlipidemia. | * [[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. | * The goal is to get the [[LDL]] down to < 100 mg/dl. | ||
| Line 31: | Line 31: | ||
==== Anti-oxidants ==== | ==== Anti-oxidants ==== | ||
* Antioxidants offer [[hepatocyte]] protection from free [[Radical (chemistry)|radical]] damage. | * [[Antioxidants]] offer [[hepatocyte]] protection from free [[Radical (chemistry)|radical]] damage. | ||
* Patients with NAFLD are recommended to use [[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> | * Patients with NAFLD are recommended to use [[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 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. | ** '''Preferred regimen (1) :''' [[Vitamin C]] 30 mg/Kg/PO/OD. | ||
Revision as of 18:08, 26 December 2017
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Non-Alcoholic Fatty Liver Disease Microchapters |
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Differentiating Non-Alcoholic Fatty Liver Disease from other Diseases |
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Non-alcoholic fatty liver disease medical therapy On the Web |
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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, withdrawal of hepatotoxic agents, and management of underlying insulin resistance/metabolic syndrome is the mainstay of treatment in non-alcoholic fatty liver disease (NAFLD).
Medical Therapy
There is no FDA approved specific treatment for NAFLD. Weight loss, withdrawal of hepatotoxic agents, and management of underlying insulin resistance/metabolic syndrome is the mainstay of treatment in non-alcoholic fatty liver disease (NAFLD).
Weight management
- Lifestyle modifications to achieve weight loss is a central aspect of management of NAFLD in obese patients.
- Weight management includes 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-lipid agents on NAFLD and liver histology has not been clearly understood.
- 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 .[1]
- Alternative regimen: Pioglitazone 4mg PO/OD.[2]
- Alternative regimen: Liraglutide 1.2 mg PO/OD.
Anti-oxidants
- Antioxidants offer hepatocyte protection from free radical damage.
- Patients with NAFLD are recommended to use 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.[6]
References
- ↑ 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.
- ↑ Bril F, Kalavalapalli S, Clark VC, Lomonaco R, Soldevila-Pico C, Liu IC, Orsak B, Tio F, Cusi K (2017). "Response to Pioglitazone in Patients With Nonalcoholic Steatohepatitis With vs Without Type 2 Diabetes". Clin. Gastroenterol. Hepatol. doi:10.1016/j.cgh.2017.12.001. PMID 29223443.
- ↑ 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.
- ↑ Vergara-Jimenez M, Almatrafi MM, Fernandez ML (2017). "Bioactive Components in Moringa Oleifera Leaves Protect against Chronic Disease". Antioxidants (Basel). 6 (4). doi:10.3390/antiox6040091. PMID 29144438.