Sometimes in obese subjects with grade two and higher fatty liver disease , in spite of all standard medical precise observation, it is difficult to treat the patient completely. What are the best therapeutics agent for this patients?
Dear Seyed,
Maybe the following recent review will help you on the subject:
Sarwar R, Pierce N, Koppe S. Obesity and nonalcoholic fatty liver disease: current perspectives. Diabetes Metab Syndr Obes 2018;11:533-542. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163009/pdf/dmso-11-533.pdf
Best wishes from Germany,
Martin
While you have not mentioned any non-pharmacological treatment mentioned still, Very Low Fatty diets and exercise with emphasis on development of belly muscles development should be made.
If not help try a low dose STATIN, it may help.
Regards
Pharmacologically, many investigators tried multiple drugs from Vitamin-E all the way to thiazolidinediones.
In brief, Vit-E :Article Effect of Vitamin E or Metformin for Treatment of Nonalcohol...
;Metformin :
Article Metformin in non-alcoholic fatty liver disease: A systematic...
did not show benefit in liver fat resolution in NAFLD.
Other drugs like Omega- 3 fatty acids- Article Effects of Purified Eicosapentaenoic and Docosahexaenoic Aci...
;Pentoxifyllin:
Article Effects of pentoxifylline on nonalcoholic fatty liver diseas...
were proven to be beneficial but there were no biggere RCTs.
GLP-1 Article Pilot study of liraglutide effects in non-alcoholic steatohe...
has got promise, but no larger studies.Pioglitazone is highly effective in improving liver histology, however it is recommended only in the case of biopsy-proven NASH, perhaps because of the associated risks of weight gain and bone loss. Article Pioglitazone, Vitamin E, or Placebo for Nonalcoholic Steatohepatitis
So, for now, the mainstay of treatment is still a low calorie diet in combination with moderate- high intensity exercise.
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