Review examines drugs, lifestyle treatments for NAFLD
The umbrella review included 27 meta-analyses of randomized controlled trials examining the effectiveness of pharmacological interventions and lifestyle modifications, including diet and exercise, for patients with nonalcoholic fatty liver disease (NAFLD).
A recent umbrella review of meta-analyses considered which drugs and lifestyle interventions were most effective for treating patients with nonalcoholic fatty liver disease (NAFLD).
Twenty-seven meta-analyses were included, 24 that evaluated randomized controlled trials (RCTs) of drugs and three that evaluated RCTs of lifestyle changes. Meta-analyses of trials including patients of any age and from any country with diagnoses ranging from mild to severe NAFLD (including nonalcoholic steatohepatitis) were eligible. Health outcomes included in the umbrella review were liver function indicators, such as alanine aminotransferase (ALT) level; anthropometric parameters, such as body mass index (BMI); lipid profile; glucose metabolism indicators; and liver histological parameters. Results were published May 18 by Obesity Reviews.
Huo Xue Hua Yu (HXHY) therapy was the most effective pharmacological intervention to improve liver function compared with placebo, but because only one meta-analysis examined this treatment, more research is needed, the authors wrote. Bicyclol, silymarin, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors were also effective, and synbiotics intake and exercising steadily under consultation with a doctor were found likely to improve liver function.
Glucagon-like peptide-1 receptor agonists and SGLT-2 inhibitors improved anthropometric parameters, while thiazolidinediones had a negative effect. Prebiotics and omega-3 fatty acids appeared to effectively reduce BMI.
Bicyclol and berberine plus metformin were effective for improving patients' lipid profile. Both treatments showed large effect size and were statistically significant, the authors noted. Resveratrol was effective in reducing homeostatic model assessment for insulin resistance (HOMA-IR) levels and improving insulin resistance, but not in lowering blood glucose levels and increasing insulin levels. Berberine and metformin together reduced blood glucose and HbA1c levels, but it is not known how they affect insulin levels. Thiazolidinediones had a positive effect on improving insulin levels but insignificant results in improving HOMA-IR.
Limitations of the review included a lack of available RCT evidence for certain treatments, such as obeticholic acid and bariatric surgery, and no consideration of side effects, the authors noted.
“Incorporating evidence from 27 meta-analyses of RCTs of pharmacological interventions and lifestyle modifications in NAFLD treatment, including approximately 30 health outcomes of five categories, this umbrella review presents an evidence-based meta-analytic view for NAFLD treatment,” they concluded. “The current review can help patients with NAFLD and clinicians make medical decisions. It can provide information on what pharmacological interventions are needed and what lifestyle modifications are available.”