Therapeutic Approach to NAFLD-NASH

Nonalcoholic fatty liver disease (NAFLD) and its progressive form nonalcoholic steatohepatitis (NASH) are the hepatic expression of metabolic syndrome and may lead to serious injury to the liver resulting in cirrhosis and hepatocellular carcinoma (HCC). Despite its seriousness, there is no definite treatment to address this life-threatening condition. Weight loss and exercise remain the cornerstone of the therapeutic treatment but also an array of medications can be used with varying degrees on liver inflammation and cirrhosis. There is also an increased risk of cardiovascular events connected to NAFLD/NASH, which should also be addressed. Statins have been shown to reduce the lipid and the inflammatory burden of the liver as well as decrease the cardiovascular risk. Aspirin also has a beneficial effect due to its anti-inflammatory properties as well as Vitamin E in certain cases. The medications (metformin, pioglitazone, GLP-1 agonists, SGLT2 inhibitors) that interfere in glucose metabolism and the activity of insulin seem to play a vital role in the metabolism of glucose and lipids and subsequent amelioration of liver function tests and the inhibition of inflammation. The aim of this review is to highlight the efficacy of current therapeutic strategies and explore the variety of the emerging new agents which target newly discovered pathways associated with the pathogenesis of NAFLD/NASH with promising results