However there was no further improvement in insulin sensitivity and liver chemistry gradually returned to pre-treatment levels.27


Another pilot study, involving 30 patients with NASH and elevated ALT, who were treated with 4mg rosiglitazone twice daily for 48 weeks, found signs of improvement by 24 weeks. These included reduced liver fat content, improved insulin sensitivity and biochemical improvement of hepatocellular injury.28

  

UDCA for the treatment of fatty liver

There are at least six label pilot studies to report UDCA at a dose of 15mg/kg/day improves liver function tests after 6-12 months of treatment.29 Patients had reduced or normalized AST in 40% cases and improved GGT in 30% cases. In addition, one study further demonstrated reduction of hepatic fat content with UDCA as seen on liver biopsies before and after treatment.30 A more recent study suggests that high dose of UDCA may benefit patients with fatty liver more.24 Its main advantage remains that the drug is free from side effects observed in PBC patients taking the drug for >11 years.

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Figure 4 : Follow up abdominal ultrasound in July 2006 showing normal gall bladder.


Fibrates have been shown to cause regression of steatosis in animals, but data from humans remain inconclusive and none of the hepatoprotective agents (eg. beta-carotene, pentoxifylline, selenium and S-adenosylmethionine) are of proven value in fatty liver.

FACTORS ASSOCIATED WITH FATTY LIVER

Factors associated with severe liver pathology in fatty liver
include:

g Age >45 years.
g AST:ALT ratio >1
g Non-specific autoantibodies
g Poorly controlled diabetes mellitus
g Metabolic syndrome
g Elevated serum hyaluronic acid