Published online Dec 28, 2015. doi: 10.4254/wjh.v7.i30.2962
Peer-review started: June 26, 2015
First decision: September 8, 2015
Revised: September 25, 2015
Accepted: December 17, 2015
Article in press: December 18, 2015
Published online: December 28, 2015
There is no single pharmacologic therapy that has been approved to treat nonalcoholic fatty liver disease in the general population. The backbone of therapy currently includes intensive lifestyle modification with established targets for diet and weight loss. The use of unsweetened, unfiltered coffee along with limiting high fructose corn syrup have emerged as beneficial dietary recommendations. The use of empiric oral hypoglycemic agents and vitamin E, however, has not been widely accepted. Developing bariatric surgical techniques are promising, but additional studies with long-term follow up are needed before it can be widely recommended. Finally, liver transplantation is an increasingly frequent consideration once complications of end-stage disease have developed. The future treatment of those with nonalcoholic fatty liver disease will likely involve a personalized approach. The importance of the gut microbiome in mediating hepatocyte inflammation and intestinal permeability is emerging and may offer avenues for novel treatment. The study of anti-fibrotic agents such as pentoxifylline and FXR agonists hold promise and new pathways, such as hepatocyte cannabinoid receptor antagonists are being studied. With the incidence of obesity and the metabolic syndrome increasing throughout the developed world, the future will continue to focus on finding novel agents and new applications of existing therapies to help prevent and to mediate the progression of nonalcoholic fatty liver disease.
Core tip: Lifestyle modification with diet and exercise remain the mainstay of therapy for nonalcoholic fatty liver disease. Loss of at least 7%-10% of body weight with limiting high fructose corn syrup and high-saturated/high glycemic index foods should be combined with regular, vigorous physical activity. The future of treatment will continue to evolve and likely include the role of anti fibrotic agents, surgical management and transplantation when indicated.