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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 (3 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 (1.8 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
  1. #Not specifically evaluated in this population
  2. BPN biopsy-proven nonalcoholic steatohepatitis, DPP4 dipeptidyl peptidase 4, GLP-1RAs glucagon-like peptide-1 receptor agonists, LHI liver histological improvement, SGLT2 sodium-glucose cotransporter-2
  3. For more details and references, please consult the respective section on this review