Pregledni rad
Treatment of Non-Alcoholic Fatty Liver Disease (NAFLD)
Tajana Filipec Kanižaj
Maja Mijić
Ivana Mikolašević
Sažetak
Weight loss is the primary therapy for most patients with NAFLD. It begins with lifestyle interventions, primarily diet modification and exercise. Overweight or obese patients are advised to lose 5-7% and patients with NASH 7-10% of body weight at a rate of 0.5 to 1.0 kg per week. Bariatric surgery can be considered for patients who do not meet weight loss goals after six months. Drug therapy is also an option in those patients who have biopsy-proven NASH with fibrosis stage ≥2 or risk factors related to the development and/or progression of fibrosis, and who fail to reach their weight loss goals. Choice of therapy also depends on whether the patient has diabetes mellitus. Current guidelines recommend that patients without diabetes mellitus take vitamin E therapy. Although metformin is considered first-line agent for the treatment of type 2 diabetes mellitus, the beneficial impact of other insulin-sensitizing agents (pioglitazone, liraglutide) on liver histology in patients with NAFLD should be taken into consideration when choosing a secondline agent for patients with NASH (who cannot take metformin or need additional glucose-lowering therapy). Given the possible side effects, all treatment options should be considered individually for each patient based on risk-benefit evaluation. Patients with NAFLD are at increased risk of developing cardiovascular diseases and often have multiple risk factors related to components of the metabolic syndrome. Therefore, the management of patients with NAFLD and diabetes and/or hypertension includes optimization of blood glucose and arterial hypertension control. Patients with hyperlipidaemia are candidates for lipid-lowering therapy.
Ključne riječi
NAFLD treatment; lifestyle interventions; vitamin E; insulin-sensitizing agents; bariatric surgery; liver transplantation
Hrčak ID:
232199
URI
Datum izdavanja:
15.1.2020.
Posjeta: 1.828 *