Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

Nonalcoholic Fatty Liver Disease 1055

General Measures

■No therapy has been proven beneficial, although metformin and

thiazolidinediones show promise.

■Standard treatment includes gradual and sustained weight loss, exer-

cise, control of diabetes and use of lipid-lowering agents, as neces-

sary to control hypertriglyceridemia

specific therapy

Treatment Options: Routine

■Gradual and sustained weight loss

■Exercise

■Control of diabetes mellitus

■Use of lipid-lowering agents, as needed

Treatment Options: Experimental

■Metformin: early results promising; long-term studies underway

■Rosiglitazone and pioglitazone: early results promising; large, mul-

ticenter studies underway

■Ursodeoxycholic acid: large randomized trial showed no benefit

■Vitamin E: small pilot studies suggest benefit

■Other hepatoprotective agents

■Phlebotomy, if associated iron overload

■Betaine: benefit demonstrated in one pilot study

■Liver transplantation for end-stage liver disease

follow-up

During Treatment

■regularly assess diet compliance, body weight, blood sugar and lipids

Routine

■Hepatic panel every 3 months

complications and prognosis

■Advanced fibrosis or cirrhosis in 10–50%

■Treat end-stage liver disease when occurs in standard fashion

■Refer for liver transplantation if end-stage liver disease

Prognosis

■Prognosis of simple fatty liver: benign

■Prognosis of NASH: risk of advanced fibrosis or cirrhosis, including

liver failure

■NASH: may recur after liver transplantation