Evaluation of metformin therapy using controlled attenuation parameter and transient elastography in patients with non-alcoholic fatty liver disease

NAFLD and Extra-Hepatic Comorbidities: Current Evidence on a Multi-Organ Metabolic Syndrome

“…In a recent study on a murine model, metformin treatment reduced markers of inflammation and lipoperoxidation in the liver and, at the same time, attenuated the loss of tight junction proteins in the small intestine, resulting in a decrease in the translocation of bacterial endotoxins in portal plasma and therefore in a protective effect upon NAFLD onset [35]. Furthermore, in a recent study on 42 NAFLD non-diabetic patients, significant reductions in hepatic steatosis and fibrosis were shown, which were evaluated by controlled attenuation parameter (CAP) and liver stiffness after five months of treatment with metformin and diet, compared to patients treated with diet alone [36]. Contrarily, a meta-analysis of 17 randomized controlled trials (RCTs) showed that 6–12 months of metformin plus lifestyle intervention did not improve liver histology or aminotransferases among NAFLD diabetic patients, compared with lifestyle intervention alone [37].…”

A prospective 5-year study on the use of transient elastography to monitor the improvement of non-alcoholic fatty liver disease following bariatric surgery

“…To the best of our knowledge, our study was the first study to evaluate the long-term treatment responses of NAFLD to bariatric surgery using TE as a monitoring tool. In the literature, TE had been tested on the roles of monitoring disease progression and response to treatment of NAFLD [21][22][23][24][25] . Suzuki et al reported the changes of LSM over 4 years in 36 patients without paired liver biopsies for monitoring disease progression of NAFLD 21 .…”

Effect of Weight Loss Medications on Hepatic Steatosis and Steatohepatitis: A Systematic Review

“…In addition to the studies described above, multiple openlabel studies compared metformin to a thiazolidinedione (24,49,70) or to lifestyle alone (12,23,25,29,47,54,64,69) with regard to improvements in liver fat or inflammation measured by MRI/MRS, CT, US, fibroscan, or biopsy. The three studies directly comparing metformin to a TZD all showed benefit of the TZD to reduce liver fat (24,49,70), whereas only one showed a significant effect of metformin, albeit smaller in magnitude than the effect of TZD (70).…”

“…The three studies directly comparing metformin to a TZD all showed benefit of the TZD to reduce liver fat (24,49,70), whereas only one showed a significant effect of metformin, albeit smaller in magnitude than the effect of TZD (70). Of 7 studies comparing effects of metformin vs. lifestyle on liver fat content (12,23,25,29,47,54,64), six showed positive effects of metformin to lower liver fat (12,23,25,29,47,54), but, in all of these studies, metformin either was not clearly superior to lifestyle or was not directly compared to lifestyle. Similarly, in the 5 studies investigating changes in hepatocellular inflammation or fibrosis (12,25,29,64,69), metformin showed trends to modestly improve inflammation and/or fibrosis in 4 of them (12,25,64,69), but none definitely demonstrated an effect that was superior to lifestyle alone.…”

“…Overall, thirty-two studies included some data on changes in ALT, AST, and/or GGT (4, 9, 12, 16, 18, 19, 21, 23-25, 28, 29, 31, 33, 35, 39, 40, 42, 43, 45-49, 51, 52, 54, 57, 59, 61, 64, 67-69). Of these, 17 reported significant reductions in at least one of these measures in the metformin group (4,12,16,19,25,28,29,35,43,45,47,48,51,52,57,68,69), but metformin was superior to natural history or lifestyle comparators in only 5 of these (12,16,35,52,69), and in no cases was it superior to TZDs or GLP-1 agonists.…”