From the Guidelines
Non-alcoholic steatohepatitis (NASH) treatment should focus on lifestyle modifications, with a weight loss goal of 7-10% through a balanced diet and regular exercise, as this approach has been shown to improve liver histology and reduce the risk of disease progression 1.
Key Recommendations
- Lifestyle modifications, including weight loss and exercise, are the cornerstone of NASH treatment, with a focus on a balanced diet and regular physical activity 1.
- A Mediterranean diet pattern is particularly beneficial for patients with NASH, as it has been shown to improve liver histology and reduce the risk of disease progression 1.
- For patients with diabetes, medications like pioglitazone, GLP-1 receptor agonists (semaglutide, liraglutide), or vitamin E (800 IU daily) in non-diabetic patients may help improve liver histology, although the use of vitamin E should be approached with caution due to potential risks 1.
- Regular monitoring with liver function tests and imaging is important, as NASH can progress to cirrhosis and liver failure if untreated 1.
- Patients should avoid alcohol completely and be cautious with medications that can stress the liver, as this can exacerbate the disease 1.
Management Approach
- Management should be multidisciplinary, addressing both liver disease and associated metabolic conditions to prevent disease progression 1.
- Clinicians should consider the patient's overall health status and medical history when developing a treatment plan, taking into account the presence of comorbidities such as diabetes, obesity, and metabolic syndrome 1.
- The use of medications such as statins and metformin should be approached with caution, as they may not be effective in treating NASH and may have potential risks 1.
From the Research
Non-Alcoholic Steatohepatitis Treatment
- There is no established treatment for non-alcoholic steatohepatitis (NASH), but several studies have investigated the efficacy of various medications, including vitamin E and pioglitazone 2, 3, 4.
- Vitamin E has been shown to improve liver histology in NASH patients without diabetes, with a significantly higher rate of improvement compared to placebo (43% vs. 19%, P=0.001) 2.
- Pioglitazone, on the other hand, has been found to improve liver histology and insulin resistance, but is associated with weight gain 2, 4.
- Other potential treatments for NASH include pentoxifylline, which has been shown to improve serum aminotransferase and liver histology in patients with biopsy-proven NASH 4.
- Lifestyle modification, including dietary counseling and regular exercise, is also crucial in the management of NASH 4, 5.
Current Management of NASH
- The current management of NASH involves a multifaceted approach, including lifestyle modification, management of associated comorbidities, and treatment of downstream pathways of inflammation and fibrosis 5.
- Physicians managing patients with NASH should focus on both the management of NASH and associated comorbidities, such as diabetes, hypertension, dyslipidaemia, and cardiovascular diseases 5.
- Screening protocols for hepatocellular carcinoma and extrahepatic malignancies are also important in the management of NASH patients 5.
Future Directions
- Despite the increasing prevalence of NASH, there is no FDA-approved treatment for this disease, and current medications are not sufficiently effective 6.
- Ongoing research is critical to evaluate potential pharmacological agents for NASH and to develop safer and more effective treatments for this disease 4, 6.