A Comprehensive Updated Review of Pharmaceutical and Nonpharmaceutical Treatment for NAFLD

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the western world with prevalence of 20–33%. NAFLD comprises a pathological spectrum. Nonalcoholic fatty liver (NAFL) is at one end and consists of simple hepatic steatosis. On the contrary, nonalcoholic steatohepatitis (NASH) consists of steatosis, inflammation, and ballooning degeneration and can progress to cirrhosis. Despite the rising incidence, definitive treatment for NAFLD, specifically NASH, has not yet been established. Lifestyle modification with dietary changes combined with regular aerobic exercise, along with multidisciplinary approach including cognitive behavior therapy, has been shown to be an effective therapeutic option, even without a significant weight loss. Pioglitazone and vitamin E have shown to be most effective in NASH patients. Surgery and weight loss medication are effective means of weight loss but can potentially worsen NASH related fibrosis. Other agents such as n-3 polyunsaturated fatty acids, probiotics, and pentoxifylline along with herbal agent such as milk thistle as well as daily intake of coffee have shown potential benefits, but further well organized studies are definitely warranted. This review focuses on the available evidence on pharmaceutical and nonpharmaceutical therapy in the treatment and the prevention of NAFLD, primarily NASH.

Efficacy and Safety of Phyllanthus Niruri in Non-alcoholic Steatohepatitis Treatment: Pilot Study from Malaysia

“…Nevertheless, it is noteworthy that, to date, no specific therapy has been approved for NASH. [5][6][7][8] Phyllanthus niruri, a herb extensively used in traditional Malay, Chinese and Ayurvedic medicine, is a potential therapeutic agent for a wide range of liver diseases, as laboratory studies have confirmed its antiviral, anti-inflammatory, antioxidant and hepatoprotective properties. [9][10][11][12][13] However, it has never been tested in patients, particularly those with NASH.…”

Past, Present, and Future of Hepatitis B and Fatty Liver in Bangladesh

“…Nonalcoholic fatty liver disease (NAFLD) has become the most common cause of liver disease and abnormal liver function test in industrialized countries [15] with prevalence of 20-33% [3]. There is lower prevalence and lower degree of liver cell injury in African American population while higher prevalence is reported in Asians and Hispanics with advanced grade of liver damage compared to other ethnicities [16].…”

“…Prevalence of HBV among children and adult both has been decreased than previous time. Nonalcoholic fatty liver disease (NAFLD) has become the most common cause of liver disease with prevalence of 20-33% [3]. In the Asia-Pacific region the prevalence of NAFLD has increased remarkably over the years affecting up to 30% of the general population [4].…”

Review on Liver Steatosis and its Impact on Liver Transplantation

“…Contrarily, concerns about vitamin E long-term safety exist as it may be associated with increased risk for cardiovascular events and prostate cancer in older patients >50years. 89 Obeticholic acid, which is a synthetic farnesoid X receptor agonist, decreased IR in T2DM and improved all NASH lesions and fibrosis in non-cirrhotic NASH patients after 72weeks of treatment.…”

“…However, not many studies have been done in humans with NAFLD to assess the effectiveness of ACE inhibitors or angiotensin receptor blockers. 89 …”