Understanding Current and Future Treatments for Liver Disease

Nonalcoholic fatty liver disease (NAFLD), is a result of fat deposition in the liver in the absence of little or no alcohol. It’s global impact is undeniable, affecting 25% of the world’s population.1 It’s more serious form, non-alcoholic steatohepatitis (NASH), can affect up to 6-8% of the world’s population1 typically associated with liver scarring, cirrhosis and complications of cirrhosis and liver failure.

Advising At-Risk Patients

The cornerstone of treatment for NAFLD is lifestyle changes. Once a patient has been identified with this disease, education on lifestyle modifications, including weight loss, staying active and making healthier food choices, is the first step in treatment. Simple changes, such as eliminating sweetened beverages like sodas and fruit juices, are recommended and patients should be encouraged to be more active.

The focus should not be “which diet?” or “which exercise?” but realistic goals to achieve weight loss, through modifying food intake accompanied with positive reinforcement and encouragement along the way.

Other aspects of lifestyle areas of focus include smoking cessation for smokers and cutting back on alcohol use for those who drink. Both smoking and alcohol can accelerate disease progression and contribute to liver fibrosis.

Weight loss is typically fast in the beginning and a plateau can be reached a few months after making changes to eating and fitness habits. Patients should be encouraged to continue efforts related to modifying eating habits, food choices and increasing and creating variation in exercise routines.

Patients should work with their primary care physicians to manage other medical problems, such as high blood pressure, type 2 diabetes and high cholesterol. Several diabetic medications have been shown to be effective in persons with type 2 diabetes and NAFLD.Cholesterol lowering medications (such as statins) are safe and can reduce inflammation in the liver,^[1]as well as have a positive impact on the natural history and complications of cirrhosis.^[2]​

The Future of Treating Liver Disease

Currently, there are no approved medical therapies, but a number of compounds exist at various stages of development to treat NAFLD at different points in the disease progression.

For now, a patient-centric chronic care management program may be the most cost-effective approach to improve NAFLD and liver scarring.

Part 4 of this series looks at the patient perspective of managing liver disease.

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^{[1] NASHNET (n.d.). https://www.nashnetwork.org/blog-posts; accessed July 10, 2020.}

^{[2]Vargas JI, Arrese M, Shah VH, Arab JP. Use of Statins in Patients with Chronic Liver Disease and Cirrhosis: Current Views and Prospects. Curr Gastroenterol Rep. 2017;19(9):43. doi:10.1007/s11894-017-0584-7. Accessed July 28, 2020.}