Recommendations for management and treatment of nonalcoholic steatohepatitis

The prevalence of nonalcoholic liver disease (NAFLD) is increasing worldwide in conjunction with the epidemic increase in obesity and metabolic risk factors. Consequently, NAFLD has become a leading indication for liver transplantation. While genetic factors play an important role in the pathogenesis of NAFLD, detrimental lifestyle trends favoring a calorically unrestricted diet rich in carbohydrates and unsaturated fat, prolonged sedentary periods or limited physical activity have major metabolic implications. In aggregate these physiological dysregulations constitute the main risk factors for the metabolic syndrome and NAFLD. The cornerstone of the treatment of NAFLD, is lifestyle changes, including modifications to diet and physical activity, to reduce body weight and liver fat, however adherence is notoriously poor and the epidemic of NAFLD continues to grow unimpeded. In the face of this unmet clinical need, the pharmacologic therapy of NAFLD has been expanding as the varied mechanistic pathways of NAFLD are elucidated. Beyond these approaches to treating NAFLD, the prevention of other liver diseases is additionally important. Chief among these is alcoholic liver disease, and heavy use is detrimental irrespective of underlying NAFLD. However, the impact of mild to moderate alcohol use in patients with mild or nonadvanced forms NAFLD is undefined. This article summarizes the results of the International Liver Transplant Society consensus meeting on NAFLD in liver transplantation. It describes the available evidence and provides consensus guidance on the lifestyle and pharmacologic therapies of NAFLD, and the consensus position on alcohol use in patients with NAFLD. Corresponding author: Prof V Ratziu, vlad.ratziu@inserm.fr Conflicts of Interest: Vlad Ratziu: consultancy or advisory board meetings for Allergan, Boehringer, Galmed, Genfit, Intercept, Novartis, Novo-Nordisk. Marwan Ghabril: Research support Salix Pharmaceutical. Manuel Romero-Gomez: consultancy or advisory board meetings for Allergan, Intercept, Medimmune, Gilead, Novo-Nordisk. Gianluca Svegliati-Baroni: Advisory board meetings for Gilead Authorship contributions: All authors took part in the meeting, the discussions and provided input on the grading of recommendations. Specific contributions include: Marwan Ghabril, text on physical exercise, Manuel Romero-Gomez, text on dietary interventions, Gianluca Svegliati-Baroni, text on alcohol consumption, Vlad Ratziu, text on pharmacological therapy. Vlad Ratziu was responsible for editing of the whole document and all authors approved the final version. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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