Advances in Therapy

, Volume 31, Issue 1, pp 30–43 | Cite as

Effect of Metformin on Ballooning Degeneration in Nonalcoholic Steatohepatitis (NASH): When to Use Metformin in Nonalcoholic Fatty Liver Disease (NAFLD)

  • Iliana Doycheva
  • Rohit LoombaEmail author


The key histologic feature of nonalcoholic steatohepatitis (NASH) is hepatocellular ballooning (HB). It plays an important role in NASH progression and is an independent predictor of liver mortality. In this review, we identified all studies using metformin in the treatment of nonalcoholic fatty liver disease (NAFLD) that included pre- and post-treatment liver biopsies. We specifically reviewed the effects of metformin on HB. Improved HB was noted in pediatric populations and in those adult patients who were able to lose weight and improve or normalize transaminases during therapy. Previous studies have supported the beneficial effects of metformin in reduction of body weight, improvement of insulin resistance, prevention of complications related to diabetes and chemo-preventive benefits in reducing hepatocellular carcinoma. All these effects make it an attractive treatment consideration for patients with diabetes, and prediabetes who have co-existing NAFLD. Future studies are warranted in order to confirm this effect of metformin on HB and its association with improving long-term outcomes in patients with NAFLD.


Body mass index Hepatocellular ballooning Liver histology Metformin Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Type 2 diabetes mellitus 



Authors are thankful to Dr. David Kleiner (NCI/NIH) who provided the liver histology images shown in this paper and Dr. Mamie Dong for her assistance in manuscript editing. No funding or sponsorship was received for this study or publication of this article.

Conflict of interest

Dr. Iliana Doycheva and Dr. Rohit Loomba declare they have no conflict of interest.

Compliance with ethics guidelines

This review article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.

Supplementary material

12325_2013_84_MOESM1_ESM.pdf (169 kb)
Supplementary material 1 (PDF 168 kb)


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Copyright information

© Springer Healthcare 2013

Authors and Affiliations

  1. 1.Division of Gastroenterology, Department of MedicineUniversity of California, San DiegoLa JollaUSA
  2. 2.Division of Epidemiology, Department of Family and Preventive MedicineUniversity of California, San DiegoLa JollaUSA

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