Fast Five Quiz: Nonalcoholic Steatohepatitis (NASH)

B.S. Anand, MD


May 11, 2020

Weight loss is a recommended treatment strategy for NASH. The American Association for the Study of Liver Diseases (AASLD) indicate that a 3%-5% weight loss reduces hepatic steatosis, but that up to a 10% weight loss might be needed to improve necroinflammation. The European Association for the Study of the Liver (EASL) recommends a weight loss target between 7% and 10%.

There is currently no pharmacotherapy approved to treat NAFLD. Management should include addressing the associated obesity, hyperlipidemia, insulin resistance, hypertension, and type 2 diabetes. Vitamin E has been shown to improve liver disease in patients without diabetes who have biopsy-proven NASH.

Even though insulin-sensitizing agents have been targeted as a potential mechanism for treatment, metformin is not recommended as a specific treatment for liver disease. Although GLP-1 agonists have been studied in patients with NAFLD and NASH, it is still too early to recommend this class of drugs. Pioglitazone may be used to treat steatohepatitis in patients with and without type 2 diabetes who have biopsy-proven NASH.

It is too early to consider foregut bariatric surgery an established option to treat NASH, although it is not specifically contraindicated in otherwise eligible individuals with NAFLD or NASH who are obese in the absence of established cirrhosis.

For additional information, refer to the 2018 practice guidelines from the AASLD, which include recommendations regarding the treatment of NAFLD, and the clinical practice guidelines for the management of NAFLD from the EASL, European Association for the Study of Diabetes, and the European Association for the Study of Obesity.


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