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Nonalcoholic Fatty Liver Disease and Obesity Treatment

Abstract

Purpose of Review

Nonalcoholic fatty liver disease (NAFLD), the most prevalent cause of chronic liver disease worldwide, is strongly associated with obesity and insulin resistance.

Recent Findings

Significant weight loss can improve NAFLD and nonalcoholic steatohepatitis (NASH). Diet and exercise that result in a sustained body weight reduction of 7–10% can improve liver fat content, NASH, and fibrosis. Vitamin E can be considered in patients with biopsy-proven NASH without diabetes, though caution must be used in those with prostate cancer. Pioglitazone improves liver histology, including fibrosis, and can be considered in patients with or without diabetes. Glucagon-like peptide-1 (GLP-1) antagonists may be beneficial in NASH, but more studies are needed before they can be recommended. Bariatric surgery, with resultant weight loss, can result in improvement in liver fat and inflammation.

Summary

NAFLD treatment includes diet and exercise with a target 7–10% weight reduction. Treatment goals include improvements in liver fat content, liver inflammation, and fibrosis.

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Fig. 1

Abbreviations

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

GLP-1:

Glucagon-like peptide-1

BMI:

Body mass index

MRI:

Magnetic resonance imaging

CT:

Computed tomography

MRS:

Magnetic resonance spectroscopy

MRE:

Magnetic resonance elastography

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

GGT:

Gamma-glutamyltransferase

NAS:

NAFLD activity score

PUFA:

Polyunsaturated fatty acids

IHTG:

Intrahepatic triglycerides

HIIT:

High-intensity interval training

SG:

Sleeve gastrectomy

RYGB:

Roux-en-Y gastric bypass

AGB:

Adjustable gastric banding

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Correspondence to Michelle T. Long.

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Katherine T. Brunner declares that she has no conflict of interest.

Cameron J. Henneberg declares that he has no conflict of interest.

Robert M. Wilechansky declares that he has no conflict of interest.

Michelle T. Long has received research funding from Echosens Corporation.

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Brunner, K.T., Henneberg, C.J., Wilechansky, R.M. et al. Nonalcoholic Fatty Liver Disease and Obesity Treatment. Curr Obes Rep 8, 220–228 (2019). https://doi.org/10.1007/s13679-019-00345-1

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Keywords

  • Nonalcoholic fatty liver disease
  • Nonalcoholic steatohepatitis
  • Obesity
  • Diabetes
  • Body mass index
  • Magnetic resonance elastography
  • NAFLD activity score
  • Intrahepatic triglycerides
  • Bariatric surgery