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476 NAFLD and CVD - Importance and Therapies

of hypertension and dyslipidemia. ll.Treatment of risk factors for cardiovascular
disease
Why treat NASH in patients with type 2 Patients with NAFLD are at increased risk for
diabetes? cardiovascular disease and often have multiple
Non-alcoholic fatty liver disease (NAFLD) is a cardiovascular disease risk factors.
frequent comorbidity in both paediatric and adult Management of patients with NAFLD includes
populations, in particular in the setting of obesity optimization of blood glucose control in patients with
and type 2 diabetes. Patients with type 2 diabetes diabetes and treatment of hyperlipidemia.
who also have NASH appear to be at a significantly
higher risk of death from cirrhosis, HCC and/or
cardiovascular disease. A. Pharmacologic therapies
Current treatment strategies: a.Vitamin E
Vitamin E decreases oxidative stress, and initial
I.General approach to the patient observational studies suggested improvement in
(i).Weight loss for patients who are overweight or aminotransferase levels in patients with NASH who
obese: received vitamin E. Not proved to be of benefit in
patients with NASH and Diabetes Mellitus.
Weight loss for all patients with NAFLD who are
overweight or obese and increased physical activity b.Insulin-sensitizing agents
can lead to sustained improvement in liver enzymes,
histology, serum insulin levels, and quality of life. The use of insulin-sensitizing agents in the treatment
of NAFLD is based upon the role insulin resistance
Options to promote weight loss include plays in the development of NAFLD.
1. Lifestyle modifications
(i)Thiazolidinediones
2. For patients who are candidates, bariatric surgery.
Thiazolidinediones, including pioglitazone and
Pharmacologic therapy can be used to aid with weight rosiglitazone, are insulin-sensitizing agents that
loss in patients who fail to achieve weight loss goals improve liver biochemical and histologic parameters in
through diet and exercise alone. patients with NASH. However, their use is associated
with adverse events, including weight gain, painful
A reasonable goal for many patients is to lose 0.5 to 1
kg/week (1 to 2 lb/week). More rapid weight reduction swollen legs, and heart failure. Thiazolidinediones is
may be associated with worsening of liver disease. used for the treatment of NASH only in patients with
type 2 diabetes.
Histologic improvement has also been observed after
bariatric surgery. (ii)Metformin
Metformin lowers blood glucose by decreasing
(ii).Vaccinations
hepatic gluconeogenesis, stimulating glucose uptake
Hepatitis A and B vaccinations should be given to by muscle, and increasing fatty acid oxidation in
patients without serologic evidence of immunity. adipose tissue. However, it does not appear to be
Additional vaccines recommended for patients effective for the treatment of NASH.
with chronic liver disease include pneumococcal
vaccination and standard immunizations (iii)Liraglutide
recommended for the population in general (eg, It is a glucagon-like peptide-1 (GLP-1)-based
influenza, diphtheria, tetanus boosters).
therapy that affects glucose control through
several mechanisms, including enhancement of
(iii).Alcohol glucose-dependent insulin secretion, slowed gastric
Patients with NAFLD should avoid all alcohol emptying, and reduction of postprandial glucagon
consumption. Heavy alcohol use is associated with and of food intake. Liraglutide may be an option for
disease progression among patients with NAFLD. It treating patients with NASH, but additional studies
is possible that light or moderate alcohol use may are needed.
have beneficial effects on the liver, and there are
potential cardiovascular benefits as well. (iv)Dipeptidyl peptidase 4 inhibitors

GCDC 2017