Table 5 Summary of the interventions to treat NAFLD according to patients’ profile
From: NAFLD as a continuum: from obesity to metabolic syndrome and diabetes
Intervention | Obesity | MetS | T2D |
|---|---|---|---|
Caloric restriction and exercise | Recommended (despite unavailable evidence of LHI) | Recommended (despite unavailable evidence of LHI) | Recommended (despite unavailable evidence of LHI) |
Orlistat | Modest benefits related to weight loss | # | # |
Bariatric/metabolic surgery | Some benefic effects (unavailable evidence of LHI) | # | # |
Metformin | No confirmed benefit | No confirmed benefit | No substantial impact, but may prevent NASH complications |
Pioglitazone | Benefic effects, including LHI May be considered for BPN | Benefic effects, including LHI May be considered for BPN | Recommended (benefic effects, including LHI) |
Vitamin E | Benefic effects, including LHI May be considered for BPN | Benefic effects, including LHI May be considered for BPN | Limited evidence of benefits Consider in combination with pioglitazone |
DPP4 inhibitors | # | # | Benefits, if any, appears to be limited |
GLP-1RAs | Benefic effects with liraglutide (3Â mg/day), similarly effective as structured lifestyle modification (unavailable evidence of LHI) Preliminary evidence of resolution of NASH and no worsening in liver fibrosis with semaglutide (press release) | # | Benefic effects with liraglutide (1.8Â mg/day), including limited evidence of LHI Preliminary studies with semaglutide are promising |
SGLT2 inhibitors | # | # | Despite the very promise preliminary results, there is still no evidence of LHI |
Sulfonylureas | # | # | Benefits, if any, appears to be limited with gliclazide |
Glinides | # | # | Poor evidence of LHI with nateglinide |
Acarbose | # | # | Very scarce data |