Non-alcoholic fatty liver disease: diet therapy and pharmacotherapy

Non-alcoholic fatty liver disease is a chronic progressive disease with variable outcome. Treatment of non-alcoholic fatty liver disease is aimed at eliminating risk factors, improving metabolic status, and preventing disease progression. The mainstay of therapy is lifestyle modification, including nutrition and physical activity. A personalized diet with the elimination of dietary risk factors and subsequent organization of rational nutrition play an important role. Pharmacotherapy for non-alcoholic fatty liver disease currently has no approved specific drugs, but some drugs are used «off-label» to reduce inflammation and fibrosis or treat concomitant metabolic disorders. For example, metformin is used in the presence of type 2 diabetes mellitus or prediabetes to improve insulin sensitivity, although its effect on liver fibrosis is limited. Thiazolidinediones such as pioglitazone can reduce liver steatosis and inflammation in patients with metabolically associated liver disease, but their use is limited to patients with a confirmed diagnosis. Vitamin E (α-tocopherol) may be useful in non-diabetic patients with NASH to reduce liver inflammation at a dose of 800 IU/day, but its long-term use requires caution due to possible side effects. Statins (atorvastatin, rosu vastatin) are widely used to control cholesterol levels and prevent cardiovascular complica tions and are safe in non-alcoholic fatty liver disease. Angiotensin II receptor antagonists (eg, losartan) may have an additional antifibrotic effect. New approaches to the treatment of non-alcoholic fatty liver disease are currently being actively studied. For example, GLP-1 agonists (liraglutide, semaglutide) and SGLT-2 inhibitors (dapagliflozin, empagliflozin), used to treat type 2 diabetes, show promising results in reducing body weight and reducing liver steatosis. Drugs with antifibrotic action, such as obeticholic acid, are also being studied.