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Greater Awareness Of Nafld, Nash In Diabetes Needed

Greater Awareness Of Nafld, Nash In Diabetes Needed

Greater Awareness of NAFLD, NASH in Diabetes Needed Greater Awareness of NAFLD, NASH in Diabetes Needed Nonalcoholic fatty liver disease may affect health outcomes in diabetes. Several issues related to nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) may overlap in patients with diabetes and clinicians should be aware of the driving factors, according to Jamie Wolosin, MD, chief of the department of medical specialties at Sharp Rees Stealy Medical Group, San Diego, California. Dr Wolosin, who discussed this topic at the American Association of Diabetes Educators (AADE) 2016 Annual Meeting , said NAFLD and NASH are extremely common and are related to the obesity epidemic. Insulin resistance and genetics are the driving factors, he noted. [NAFLD/NASH] is a very common disorder that is linked to obesity, type 2 diabetes, insulin resistance, and metabolic syndrome. It is present in greater than 50% of overweight patients with type 2 diabetes. Its presence is associated not only with increased liver morbidity and mortality but also cardiovascular disease, said Dr Wolosin. Although NAFLD alone is relatively benign, he explained, NASH has significant morbidity risk. NAFLD is defined as hepatic steatosis with no other known cause of hepatic fat accumulation and no evidence of excessive alcohol use. Excessive alcohol use in this case is defined as 3 drinks per day for men and 2 drinks per day for women. NAFLD is also defined by the presence of fat via imaging or biopsy of the liver. The current standard of care for NAFLD/NASH calls for sustained gradual weight loss along with exercise, noted Dr Wolosin. Pharmacologic therapies for NASH currently are in early stages of development. This is an important area for endocrinologists to address because Continue reading >>

Nonalcoholic Fatty Liver Disease: New Treatments

Nonalcoholic Fatty Liver Disease: New Treatments

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver dysfunction in the western world [1] because of its close association with obesity, insulin resistance and dyslipidaemia; it is therefore considered the hepatic manifestation of the metabolic syndrome. A particular health concern is patients with nonalcoholic steatohepatitis (NASH) with accompanying hepatocellular injury that can lead to progressive liver fibrosis, cirrhosis and hepatocellular carcinoma (HCC) as well as increased cardiovascular risk [1] . At present, there is no approved therapy for NASH and the optimal treatment remains uncertain; effective therapies are thus a research priority to reduce the anticipated burden of liver disease. The rationale for therapeutic approaches is centred on the concept that while simple steatosis has not been associated with morbidity, NASH is associated with a more than 10-fold increased risk of liver-related death (2.8 vs. 0.2%) and a doubling of cardiovascular risk [2] ; at the time of diagnosis, 2533% of patients with NASH have advanced fibrosis, including cirrhosis [3,4] . After adjustment for confounders, NASH has a similar fibrotic potential to that of chronic hepatitis C [3,4] . Pooled data suggest that about 21% of patients with NASH will have some regression of fibrosis while 38% of patients will progress over 5.3 years follow-up [3] , results that have recently been confirmed in a dual-biopsy Northern European population [5] . Weight reduction is recommended as the initial step in management of NASH. Pharmacological agents such as orlistat may help achieve weight loss; however, whether these confer additional independent benefit beyond that due to weight loss is unclear [6,7] . Lifestyle modification therefore remains the primary therapy for Continue reading >>

Guidelines For Nonalcoholic Fatty Liver Disease Issued

Guidelines For Nonalcoholic Fatty Liver Disease Issued

Guidelines for Nonalcoholic Fatty Liver Disease Issued This article is intended for primary care clinicians, gastroenterologists, hepatologists, and other specialists who provide care to adults with nonalcoholic fatty liver disease. The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care. Upon completion of this activity, participants will be able to: Describe the indications for liver biopsy in patients with nonalcoholic fatty liver disease. Describe first-line pharmacotherapy for nondiabetic adults with biopsy-proven nonalcoholic fatty liver disease. As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships. Disclosure: Brande Nicole Martin, MA, has disclosed no relevant financial relationships. Disclosure: Penny Murata, MD, has disclosed no relevant financial relationships. Disclosure: Cynthia Fontan has disclosed no relevant financial relationships. Accreditation Coordinator, Continuing Professional Education Department, MedscapeCME; Clinical Assistant Professor, School of Nursing and Allied Heal Continue reading >>

Treatment Of Nonalcoholic Fatty Liver Disease (nafld) In Patients With Type 2 Diabetes Mellitus

Treatment Of Nonalcoholic Fatty Liver Disease (nafld) In Patients With Type 2 Diabetes Mellitus

Abstract Nonalcoholic fatty liver disease (NAFLD) is believed to be the most common chronic liver disease, affecting at least one-third of the population worldwide. The more aggressive form is known as nonalcoholic steatohepatitis (NASH) and characterized by hepatocyte necrosis and inflammation. The presence of fibrosis is not uncommon. Fibrosis indicates a more aggressive course and patients with NASH that are at high-risk of cirrhosis and premature mortality, as well as at increased risk of hepatocellular carcinoma (HCC). Patients with type 2 diabetes mellitus (T2DM) are at the highest risk for the development of NASH, even in the setting of normal plasma aminotransferase levels. The presence of dysfunctional adipose tissue in most overweight and obese subjects, combined with insulin resistance, hyperglycemia, and atherogenic dyslipidemia, contribute to their increased cardiovascular risk. Many therapeutic agents have been tested for the treatment of NASH but few studies have focused in patients with T2DM. At the present moment, the only FDA-approved agents that in controlled studies have shown to significantly improve liver histology in patients with diabetes are pioglitazone and liraglutide. Current research efforts are centering on the mechanisms for intrahepatic triglyceride accumulation and for the development of steatohepatitis, the role of mitochondrial dysfunction in NASH, and the impact of improving glycemic control per se on the natural history of the disease. This brief review summarizes our current knowledge on the pharmacological agents available for the treatment of NASH to assist healthcare providers in the management of these challenging patients. Keywords Nonalcoholic fatty liver disease (NAFLD)Nonalcoholic steatohepatitis (NASH)Type 2 diabetes mellit Continue reading >>

Current Efforts And Trends In The Treatment Of Nash - Sciencedirect

Current Efforts And Trends In The Treatment Of Nash - Sciencedirect

Volume 62, Issue 1, Supplement , April 2015, Pages S65-S75 Current efforts and trends in the treatment of NASH Author links open overlay panel VladRatziu1 Of all the aspects of non-alcoholic fatty liver disease (NAFLD), the slowest advances have occurred in the therapeutic field. Thirty-five years after its formal description and after 15 years of intense scrutiny from researchers worldwide, there is still no approved drug for the treatment of non-alcoholic steatohepatits (NASH). In the meantime, progress in the understanding of pathophysiology, diagnosis both invasive and non-invasive, epidemiology and even natural history have been substantial or, at times, spectacular. In contrast, hepatitis C virus (HCV) therapy underwent constant improvement and even before the great acceleration of the past few years, patients were already being offered approved therapies that were increasingly more efficient. What then explains such a slow pace of therapeutic advances in NASH, and will this change in the near future? Here we will review commonly-held myths that have diverted attention from therapy of NASH, obstacles that have slowed down industrial development of drugs for this indication, and recent achievements that will create better conditions for drug development programs. We will also briefly review current knowledge of non-pharmacological and pharmacological management in this early era of NASH therapies. Continue reading >>

Current And Future Pharmacological Therapies For Nafld/nash

Current And Future Pharmacological Therapies For Nafld/nash

, Volume 53, Issue3 , pp 362376 | Cite as Current and future pharmacological therapies for NAFLD/NASH Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease worldwide, and there is no approved pharmacotherapy. The efficacy of vitamin E and pioglitazone has been established in nonalcoholic steatohepatitis (NASH), a progressive form of NAFLD. GLP-1RA and SGLT2 inhibitors, which are currently approved for use in diabetes, have shown early efficacy in NASH, and also have beneficial cardiovascular or renal effects. Innovative NASH therapies include four main pathways. The first approach is targeting hepatic fat accumulation. Medications in this approach include modulation of peroxisome proliferator-activator receptors (e.g., pemafibrate, elafibranor), medications targeting farnesoid X receptor axis [obeticholic acid; OCA)], inhibitors of de novo lipogenesis (aramchol, ACC inhibitor), and fibroblast growth factor-21 analogues. A second target is oxidative stress, inflammation, and apoptosis. This class of drug includes apoptosis signaling kinase 1 (ASK1) inhibitor and emricasan (an irreversible caspase inhibitor). A third target is intestinal microbiomes and metabolic endotoxemia. Several agents are in ongoing trials, including IMMe124, TLR4 antagonist, and solithromycin (macrolide antibiotics). The final target is hepatic fibrosis, which is strongly associated with all-cause or liver-related mortality in NASH. Antifibrotic agents are a cysteinecysteine motif chemokine receptor-2/5 antagonist (cenicriviroc; CVC) and galectin 3 antagonist. Among a variety of medications in development, four agents such as OCA, elafibranor, ASK1 inhibitor, and CVC are currently being evaluated in an international phase 3 trial for the treatment of NASH. Within the next fe Continue reading >>

Pioglitazone Vs Vitamin E Vs Placebo For Treatment Of Non-diabetic Patients With Nonalcoholic Steatohepatitis (pivens) (pivens)

Pioglitazone Vs Vitamin E Vs Placebo For Treatment Of Non-diabetic Patients With Nonalcoholic Steatohepatitis (pivens) (pivens)

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Number of Participants With Improvement in Non-alcoholic Fatty Liver Disease (NAFLD) Activity Defined by Change in Standardized Scoring of Liver Biopsies at Baseline and After 96 Weeks of Treatment. [TimeFrame:baseline and 96 weeks] Total nonalcoholic fatty liver disease (NAFLD) activity was assessed on a scale of 0 to 8, with higher scores indicating more severe disease; the components of this measure include steatosis (assessed on a scale of 0 to 3), lobular inflammation (assessed on a scale of 0 to 3), and hepatocellular ballooning (assessed on a scale of 0 to 2). The primary outcome was an improvement in histological findings from baseline to 96 weeks, which required an improvement by 1 or more points in the hepatocellular ballooning score; no increase in the fibrosis score; and either a decrease in the activity score for nonalcoholic fatty liver disease to a score of 3 or less or a decrease in the activity score of at least 2 points, with at least a 1-point decrease in either the lobular inflammation or steatosis score. Number of Participants With Improvement in Steatosis [TimeFrame:baseline and 96 weeks] Steatosis is assessed on a scale of 0 to 3 with higher scores indicating more severe steatosis. This secondary outcome measure is the number of participants that experienced a decrease in steatosis score, which indicates improvement in steatosis. Number of Participants With Improvement in Lobular Inflammation [TimeFrame:baseline and 96 weeks] Lobular inflammation is assessed on a scale of 0 to 3 with higher scores indicating more severe lobular inflammation. This secondary outcome measure is the number of participants that experience Continue reading >>

Diabetes Medicine Reduces Liver Fat In Nonalcoholic Fatty Liver Disease

Diabetes Medicine Reduces Liver Fat In Nonalcoholic Fatty Liver Disease

Follow all of ScienceDaily's latest research news and top science headlines ! Diabetes medicine reduces liver fat in nonalcoholic fatty liver disease In people with type 2 diabetes, nonalcoholic fatty liver disease (NAFLD) is common and can progress to a severe liver disease known as nonalcoholic steatohepatitis (NASH). Now a study has found that empagliflozin, a newer treatment for type 2 diabetes, reduces liver fat in patients with NAFLD and diabetes. In people with type 2 diabetes, nonalcoholic fatty liver disease (NAFLD) is common and can progress to a severe liver disease known as nonalcoholic steatohepatitis (NASH). Now a study has found that empagliflozin, a newer treatment for type 2 diabetes, reduces liver fat in patients with NAFLD and diabetes. Results of the randomized controlled study, called the E-LIFT Trial, will be presented Monday at the Endocrine Society's 100th annual meeting in Chicago, Ill., during a late-breaking abstracts session. Diabetes medications in the same class as empagliflozin have decreased liver fat in rodents with a buildup of fat in the liver, but in humans the effect of empagliflozin on liver fat has not been previously reported, said the study's senior investigator, Ambrish Mithal, M.D., chair of the Division of Endocrinology and Diabetes at Medanta The Medicity Hospital, Gurugram, India. "Despite the fact that NASH may progress to cirrhosis of the liver and liver cancer, there are no approved medications for treating NASH or NAFLD, and agents like metformin, pioglitazone and vitamin E have had limited success in reducing liver fat," Mithal said. "Our results suggest that empagliflozin may help in treating NAFLD." The study, funded by the Endocrine and Diabetes Foundation India in New Delhi, included 50 patients who were 40 years o Continue reading >>

Nonalcoholic Fatty Liver Disease

Nonalcoholic Fatty Liver Disease

Fatty liver disease means that you have fat deposits inside your liver. These deposits may keep your liver from doing a good job of removing toxins from your blood. People who drink too much alcohol may also have fat in their liver. But that’s not the same as fatty liver disease. Types of fatty liver disease Health care providers divide fatty liver disease into 2 types. If you just have fat but no damage to your liver, the disease is called nonalcoholic fatty liver disease (NAFLD). If you have fat in your liver plus signs of inflammation and liver cell damage, the disease is called nonalcoholic steatohepatitis (NASH). About 10% to 20% of Americans have NAFLD. About 2% to 5% have NASH. Symptoms Fatty liver disease is sometimes called a silent liver disease. This is because it can happen without causing any symptoms. Most people with NAFLD live with fat in their liver without developing liver damage. A few people who have fat in their liver develop NASH. If you have NASH, you may have symptoms. But it could take years for them to develop. If liver damage from NASH leads to permanent scarring and hardening of your liver, this is called cirrhosis. Symptoms from NASH may include: Severe tiredness Weakness Weight loss Yellowing of the skin or eyes Spiderlike blood vessels on the skin Long-lasting itching NASH that turns into cirrhosis could cause symptoms like fluid retention, internal bleeding, muscle wasting, and confusion. People with cirrhosis over time may develop liver failure and need a liver transplant. Who's at risk Health care providers don’t know the exact cause of fatty liver disease. But they think that obesity is the most common cause. Obesity in the U.S. has doubled in the last decade, and health care providers are seeing a steady rise in fatty liver diseas Continue reading >>

Pivens

Pivens

In Review Among patients without diabetes and with nonalcoholic steatohepatitis, does pioglitazone or vitamin E perform better than placebo for the treatment of disease? Bottom Line Vitamin E was superior to placebo for the treatment of nonalcoholic steatohepatitis in adults without diabetes, and pioglitazone may also have efficacy. Major Points Nonalcoholic steatohepatitis is a common liver disease that is characterized histologically by hepatic steatosis, lobular inflammation, and hepatocellular ballooning; it can progress to cirrhosis in up to 15% of patients. There is currently no therapy that is of proven benefit for nonalcoholic steatohepatitis. The disease is closely associated with insulin resistance and features of the metabolic syndrome such as obesity, hypertriglyceridemia, and type 2 diabetes. In addition to insulin resistance, oxidative stress has been implicated as a key factor contributing to hepatic injury in patients with nonalcoholic steatohepatitis. Thus, both insulin resistance and oxidative stress are attractive targets for therapy in patients with this disease. Several pilot studies have provided evidence that insulin sensitizers such as thiazolidinediones and antioxidants such as vitamin E improve clinical and histologic features of nonalcoholic steatohepatitis. The medical evidence of a benefit, however, is limited, because these studies had small samples and were performed at single centers. Moreover, a recent multicenter trial showed a reduction in hepatic steatosis but no improvement in markers of cell injury after a year of rosiglitazone therapy. The value of these drugs remains uncertain. The Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) was established by the National Institute of Diabetes and Digestive and Kidney Diseas Continue reading >>

Pioglitazone For Patients With Diabetes And Nonalcoholic Steatohepatitis | Annals Of Internal Medicine | American College Of Physicians

Pioglitazone For Patients With Diabetes And Nonalcoholic Steatohepatitis | Annals Of Internal Medicine | American College Of Physicians

Nonalcoholic fatty liver disease (NAFLD) is a growing global public health problem and is now recognized as the most common cause of chronic liver disease in the United States and other industrialized countries ( 1 ). The prevalence of NAFLD has increased in parallel with the dramatic increase in obesity and type 2 diabetes mellitus (T2DM), and it is now estimated to occur in more than 30% of the adult U.S. population ( 1 ). Although most patients with NAFLD have simple steatosis and a relatively benign clinical course, a smaller proportion develop nonalcoholic steatohepatitis (NASH), which may progress to cirrhosis and liver cancer and increases the risk for cardiovascular and chronic kidney disease ( 1 ). Moreover, the presence of NASH and significant fibrosis increases the likelihood of all-cause death, liver transplantation, and liver-related complications ( 2 , 3 ). The presence of T2DM in patients with NASH is strongly associated with fibrosis severity and mortality risk ( 4 ). Therefore, patients with T2DM particularly need therapies that modify the natural history of NAFLD and NASH. Continue reading >>

The Connection Between Vitamin E And Patients With Diabetes And Nonalcoholic Steatohepatitis

The Connection Between Vitamin E And Patients With Diabetes And Nonalcoholic Steatohepatitis

The Connection Between Vitamin E and Patients with Diabetes and Nonalcoholic Steatohepatitis Presented: Monday, November 16, 2015 - 12:00 pm - Moscone West Convention Center Nov 17, 2015, 09:35 ET from American Association for the Study of Liver Diseases (AASLD) SAN FRANCISCO, Nov. 17, 2015 /PRNewswire/ --There have been numerous studies on the safety and efficacy of using vitamin E to treat nondiabetic patients with nonalcoholic steatohepatitis (NASH), but researchers at the annual meeting of the American Association for the Study of Liver Diseases ( AASLD ) presented results of vitamin E in diabetic and nondiabetic patients. According to the study's principal investigator Kris Kowdley, MD, FAASLD, Director of the Liver Care Network and Organ Care Research at Swedish Medical Center, in Seattle, Washington, USA this is the first time data on diabetic patients with NASH is being presented, and the results show that vitamin E shows the same efficacy in patients with diabetes as in those without diabetes. NASH is a metabolic disorder that resembles alcoholic liver disease but occurs in patients who drink little or no alcohol and can occur in children to the elderly, as well as people with and without diabetes. Vitamin E has been studied as a treatment for NASH in the PIVENS trial which included subjects without diabetes. The investigators previously showed that vitamin E showed histologic improvement non-diabetic patients with NASH. The FLINT trial of obeticholic acid versus placebo allowed patients with diabetes to be enrolled; the trial was stopped early because it met its primary endpoint and demonstrated significant histologic improvement with obeticholic acid. Concomitant vitamin E use was permitted in study subjects in the FLINT study. In the study presented at this Continue reading >>

Nash Therapy: Omega 3 Supplementation, Vitamin E, Insulin Sensitizers And Statin Drugs

Nash Therapy: Omega 3 Supplementation, Vitamin E, Insulin Sensitizers And Statin Drugs

Go to: OMEGA 3 FATTY ACID (PUFA, OMEGA-3, ‘FISH OIL’ SUPPLEMENTS) PUFA (polyunsaturated fatty acids) are important lipid nutrients which constitute key fatty acid components of the triglyceride/diglyceride and phospholipid membranes of cells and sub-cellular organelle membranes such as the endoplasmic reticulum and the mitochondria [2]. The fatty acid composition of these phospholipid membranes influences susceptibility to free-radical induced oxidative injury and to activation of inflammatory and anti-inflammatory pathways through their metabolism to structurally related prostaglandins and leukotrienes. These agents also act as ligands for nuclear receptors to stimulate transcription of genes involved in lipid and energy metabolism [3]. In the most straight forward perspective, PUFA can be seen as consisting of two nutritionally essential 18 carbon fatty acids which are usually ingested as components of ester links of three fatty acids linked to a three carbon glycerol backbone (i.e. triacylglycerides or ‘triglycerides’): 1. Linoleic Acid 18:2 (9,12) also known as Omega 6 (N6) fatty acids and 2. Linolenic Acid 18:3 (9,12,15) also known as Omega 3 (N3) fatty acids. The nomenclature and biochemistry of these agents and their downstream metabolites is remarkably complex. ‘Unsaturated’ refers to the presence of carbo-carbon double bonds (minus a hydrogen bond) with the number of double bonds indicated as 2 or 3 in the formal name and the indication of the position of the ‘first’ double bond from one terminal of the molecule: hence the terms ‘N3 or N6’. Note that N6 fatty acids have two double bonds and that N3 have three double bonds. They are considered ‘essential’ because the body cannot synthesize these fatty acids from other precursors. End prod Continue reading >>

Nafld And Diabetes Mellitus

Nafld And Diabetes Mellitus

nature reviews gastroenterology & hepatology Herbert Tilg is Chair of the Department of Gastroenterology, Hepatology and Endocrinology at Medical University Innsbruck, Austria. He was trained at Medical University Innsbruck and did a Research Fellowship at Tufts University, Boston, USA, with Charles Dinarello. His research focus had been the role of (adipo)cytokines and gut microbiota in gastrointestinal disorders, with a special focus on fatty liver diseases. In the past he has been representative of the European Association for the Study of the Liver, the European Crohn's and Colitis Organisation and United European Gastroenterology. Alexander Moschen is gastroenterologist and assistant professor of medicine at the Department of Internal Medicine 1, Medical University Innsbruck, Austria. After his training in Innsbruck, he did a 1-year senior clinical fellowship in gastroenterology and endoscopy at University of Cambridge, UK. His main research interests are intestinal immunity and microbiotahost interactions in the context of IBD and NAFLD. Michael Roden is Chair of Endocrinology and Metabolic Diseases at Heinrich Heine University Dsseldorf, Germany, and Director of the Department of Endocrinology and Diabetology at University Hospital Dsseldorf and of the German Diabetes Center (DDZ). He was trained at the University of Vienna, Austria, and served as Max-Kade Fellow at Yale University, USA. Dr Roden has contributed concepts to nutrient-induced insulin resistance and hepatic and muscle energy metabolism. He has received the European Society for Clinical Investigation award for excellence in clinical science, the Oskar-Minkowski and Somogyi awards and honorary doctorates of the universities of Athens, Greece, and Belgrade, Serbia. He was representative of the Europea Continue reading >>

Pioglitazone, Vitamin E, Or Placebo For Nonalcoholic Steatohepatitis. F1000:

Pioglitazone, Vitamin E, Or Placebo For Nonalcoholic Steatohepatitis. F1000: "changes Clinical Practice"

Pioglitazone, Vitamin E, or Placebo for Nonalcoholic Steatohepatitis. F1000: "Changes Clinical Practice" Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, Neuschwander-Tetri BA, Lavine JE, Tonascia J, Unalp A, Van Natta M, Clark J, Brunt EM, Kleiner DE, Hoofnagle JH, Robuck PR, NASH CRN Commentary from Faculty Members Vittorio Di Maso and Stefano Bellentani, Ospedale Ramazzini, Italy, Gastroenterology & Hepatology Changes Clinical Practice: Vitamin E (800 international units daily) should be used for the medical treatment of non-diabetic adult patients affected by the nonalcoholic steatohepatitis (NASH) form of nonalcoholic fatty liver disease (NAFLD). New drugs for the treatment of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are urgently needed. This article gives us milestone practical information by showing, in a large series of non-diabetic NAFLD patients participating in a double-blind randomized trial, that vitamin E treatment is associated with an improvement in the histologic grade of inflammation in NAFLD. At present, no established treatment for NASH is available, and there is a lack of randomized trials. This study reports the results of a multicenter, randomized, placebo-controlled, double-blind clinical trial testing either insulin-resistance reduction (pioglitazone) or oxidative stress reduction therapy (vitamin E) against placebo. The authors studied 247 US subjects with NAFLD and without diabetes, assessing NAFLD histology before and after treatments. Histology was reviewed by a pathology committee. Only vitamin E treatment showed a significant improvement in the histologic findings fitting the primary outcome. Also, pioglitazone fitted some secondary outcomes, showing its possible role in NAFLD tr Continue reading >>

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