The FDA approved semaglutide for obesity management in 2021.
Cirrhosis from nonalcoholic fatty liver disease (NAFLD) is becoming increasingly common in the United States.
Endocrinologists may miss diagnosing NAFLD in adults with obesity or type 2 diabetes mellitus, who are at the highest risk.
Recent studies indicate that glucagon-like peptide-1 receptor agonists (GLP-1RAs) may be beneficial for treating nonalcoholic steatohepatitis () in these patients.
Multidisciplinary teams led by endocrinologists are essential for implementing screening and treatment guidelines for NAFLD.
Current pharmacological treatment options for NAFLD are limited to vitamin E for non-diabetic patients and diabetes medications, including GLP-1RAs, that reverse steatohepatitis.
Simplified
CONTEXT: The burden of cirrhosis from nonalcoholic fatty liver disease (NAFLD) is reaching epidemic proportions in the United States. This calls for greater awareness among endocrinologists, who often see but may miss the diagnosis in adults with obesity or type 2 diabetes mellitus (T2D) who are at the highest risk. At the same time, recent studies suggest that glucagon-like peptide-1 receptor agonists (GLP-1RAs) are beneficial vs nonalcoholic steatohepatitis () in this population. This minireview aims to assist endocrinologists to recognize the condition and recent work on the role of GLP-1RAs in NAFLD/NASH.
EVIDENCE ACQUISITION: Evidence from observational studies, randomized controlled trials, and meta-analyses.
EVIDENCE SYNTHESIS: Endocrinologists should lead multidisciplinary teams to implement recent consensus statements on NAFLD that call for screening and treatment of clinically significant fibrosis to prevent cirrhosis, especially in the high-risk groups (ie, people with obesity, prediabetes, or T2D). With no US Food and Drug Administration (FDA)-approved agents, weight loss is central to successful management, with pharmacological treatment options limited today to vitamin E (in people without T2D) and diabetes medications that reverse steatohepatitis, such as pioglitazone or . Recently, the benefit of GLP-1RAs in NAFLD, suggested from earlier trials, has been confirmed in adults with biopsy-proven NASH. In 2021, the FDA also approved semaglutide for obesity management.
CONCLUSION: A paradigm change is developing between the endocrinologist's greater awareness about their critical role to curve the epidemic of NAFLD and new clinical care pathways that include a broader use of GLP-1RAs in the management of these complex patients.
Key numbers
39%
resolution rate
Resolution of in patients treated with liraglutide vs. placebo.
19% to 32%
Liver fat reduction range
Percentage reduction in liver fat content observed with treatment.
70%
Prevalence of NAFLD in T2D
Percentage of T2D patients found to have NAFLD.
Full Text
We can’t show the full text here under this license.
