Topic Highlight
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 28, 2015; 7(30): 2962-2967
Published online Dec 28, 2015. doi: 10.4254/wjh.v7.i30.2962
Management of non-alcoholic fatty liver disease in 2015
Neel Malhotra, Melanie D Beaton
Neel Malhotra, Melanie D Beaton, Department of Medicine, Division of Gastroenterology, Western University, London, ON N6A 3A5, Canada
Melanie D Beaton, London Health Sciences Centre, University Hospital, London, ON N6A 5A5, Canada
Author contributions: Malhotra N and Beaton MD analyzed the literature and wrote the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Melanie D Beaton, London Health Sciences Centre, University Hospital, Room A10-223, 339 Windermere Road, London, ON N6A 5A5, Canada.
Telephone: +1-519-6633344 Fax: +1-519-6633220
Received: June 25, 2015
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.

Keywords: Lobular inflammation, Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Liver fibrosis

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.