Medical Approach for Weight Loss in Nonalcoholic Fatty Liver Disease
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FATTY LIVER DISEASE (V AJMERA, SECTION EDITOR)
Medical Approach for Weight Loss in Nonalcoholic Fatty Liver Disease Albert Do 1 & Ysabel C. Ilagan-Ying 2 & Wajahat Z. Mehal 1 Published online: 21 November 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose of Review Nonalcoholic fatty liver disease (NAFLD) has reached epidemic proportions due to obesity in the modern world. Although treatments are in development, weight loss remains the most definitive and impactful approach to treating this disease and with it the other multisystemic complications of obesity. In this review, we summarize the current medical therapies for weight loss in NAFLD, including patient evaluation, counseling, and incorporation of medications for obesity. Recent Findings Despite need for weight loss as treatment for NAFLD, few achieve successful weight loss. Weight loss medications lead to weight loss of 5 to 10%, the amount expected to improve NAFLD steatosis and fibrosis. Ultimately, a multimodal approach is necessary to achieve successful weight loss. Summary Medical management for weight loss in NAFLD requires fibrosis staging and developing a patient-centered approach to assessment of patient weight and behavioral change goals. Keywords Steatohepatitis . Obesity . Pharmacology . Weight loss medications . Diet . Exercise
Abbreviations BMI Body mass index CP Child Pugh EBT Endoscopic bariatric therapies FDA Food and Drug Administration NAFL Nonalcoholic fatty liver NAFLD Nonalcoholic fatty liver disease NASH Nonalcoholic steatohepatitis
Introduction Nonalcoholic fatty liver disease (NAFLD) is now the most common chronic liver disease in the world with an
This article is part of the Topical Collection on Fatty Liver Disease * Albert Do [email protected] 1
Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, 1080 LMP, PO Box 208019, New Haven, CT, USA
2
Yale School of Medicine, New Haven, CT, USA
estimated prevalence of 24% globally and is occurring in the setting of the obesity epidemic [1••, 2]. NAFLD is now the second-leading but fastest growing indication for liver transplantation in the USA [3, 4]. Its severe form, nonalcoholic steatohepatitis (NASH), is associated with cardiovascular disease, hepatic fibrosis, cirrhosis, and associated complications including portal hypertension and hepatocellular carcinoma [5•]. These patients may also suffer from other medical issues throughout liver transplant assessment, including ethical considerations for transplant candidacy in the setting of obesity, sarcopenia, prolonged operative times, and posttransplantation weight gain [6, 7••]. As there are currently no US Food and Drug Administration (FDA)-approved drugs for NAFLD, screening for NASH even in high-risk populations at this time is not recommended due to low cost-effectiveness [8]. Although promising medications to treat steatohepatitis are forthcoming, weight loss is currently the only curative treatment for this disease. Thus, treatment curr
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