Nonalcoholic steatohepatitis: emerging targeted therapies to optimize treatment options.
Diet and lifestyle changes have led to worldwide increases in the prevalences of obesity and metabolic syndrome, resulting in substantially greater incidence of nonalcoholic fatty liver disease (NAFLD). NAFLD is considered a hepatic manifestation of metabolic syndrome and is related to diabetes, insulin resistance, central obesity, hyperlipidemia, and hypertension. Nonalcoholic steatohepatitis (NASH) is an entity that describes liver inflammation due to NAFLD. Growing evidence suggests that NAFLD is a multisystem disease with a clinical burden that is not only confined to liver-related morbidity and mortality, but that also affects several extra-hepatic organs and regulatory pathways. Thus, NAFLD is considered an important public health issue, but there is currently no effective therapy for all NAFLD patients in the general population. Studies seeking optimal therapy for NAFLD and NASH have not yet led to development of a universal protocol for treating this growing problem. Several pharmacological agents have been studied in an effort to improve insulin resistance and the proinflammatory mediators that may be responsible for NASH progression. Cardiovascular risk factors are highly prevalent among NASH patients, and the backbone of treatment regimens for these patients still comprises general lifestyle interventions, including dietary changes and increased physical activity. Vitamin E and thiazolidinedione derivatives are currently the most evidence-based therapeutic options, but only limited clinical evidence is available regarding their long-term efficacy and safety. Vitamin D and renin-angiotensin-aldosterone system blockers are promising drugs that are currently being intensively investigated for use in NAFLD/NASH patients.
['Milic|Sandra|S|', 'Mikolasevic|Ivana|I|', 'Krznaric-Zrnic|Irena|I|', 'Stanic|Marija|M|', 'Poropat|Goran|G|', 'Stimac|Davor|D|', 'Vlahovic-Palcevski|Vera|V|', 'Orlic|Lidija|L|']
D000465:Algorithms D047228:Angiotensin II Type 1 Receptor Blockers D000806:Angiotensin-Converting Enzyme Inhibitors D000818:Animals D019091:Critical Pathways D003661:Decision Support Techniques D006801:Humans D015994:Incidence D008019:Life Style D065626:Non-alcoholic Fatty Liver Disease D015995:Prevalence D012084:Renin-Angiotensin System D012307:Risk Factors D040242:Risk Reduction Behavior D045162:Thiazolidinediones D016896:Treatment Outcome D014807:Vitamin D
therapy metabolic syndrome nonalcoholic fatty liver disease insulin resistance