Review article: the treatment of fatty liver disease associated with the metabolic syndrome

Summary Treatment of non-alcoholic fatty liver disease (NAFLD) may be worth to prevent progression to advanced liver failure, but no therapy is definitely evidence-based. Weight loss or lifestyle modifications remain indeed the primary line of intervention, particularly in overweight or obese subjects. In adult NAFLD, they are effective in the short-term, but require a multidisciplinary team approach, that is rarely available in liver units. Insulin-sensitizing agents are probably the treatment of choice. They definitely reduce the insulin resistance that promotes steatosis. Several uncontrolled and controlled studies have documented an improvement in liver biochemistry and in histology, but the long-term results remain unsettled. This is an area where significant advances are expected in the next few years.