Current guidelines for the management of non-alcoholic fatty liver disease: A systematic review with comparative analysis

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Term Occurence Count Dictionary
pioglitazone 9 endocrinologydiseasesdrugs
type 2 diabetes mellitus 3 endocrinologydiseases
Insulin 1 endocrinologydiseasesdrugs
diabetes mellitus 6 endocrinologydiseases
metabolic syndrome 6 endocrinologydiseases
metformin 1 endocrinologydiseasesdrugs
obesity 6 endocrinologydiseases

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Select Drug Character Offset Drug Term Instance
Insulin 8916 causes of steatosisNo other causes of steatosisNo other causes of steatosisNo other causes of steatosis Insulin resistanceNo significant alcohol consumptionNo significant alcohol consumptionNo significant alcohol
metformin 36197 to the evidence of its limited efficacy in improving the histological features of NAFLD[[43]-[45]], metformin is not recommended by any guidelines to specifically treat NAFLD[[3]-[8]].Pioglitazone: Pioglitazone,
pioglitazone 34784 non-diabetic, biopsy-proven NASHPPAR-gamma agonistsConsider use in selected diabetic patientsConsider pioglitazone in adults regardless of diabetesInsufficient evidence in AsianInsufficient evidence, potentially usefulPioglitazone
pioglitazone 36448 proliferator-activated receptor (PPAR) gamma agonist with insulin-sensitising effects. Treatment with pioglitazone improves insulin sensitivity, aminotransferases, steatosis, inflammation, and ballooning in patients
pioglitazone 36664 with NASH and prediabetes or T2DM[[46]]. The PIVENS trial (a large multicenter RCT) compared low dose pioglitazone (30 mg/d) vs vitamin E (800 UI/d) vs placebo for two years in patients without overt diabetes. Pioglitazone
pioglitazone 37125 side effects of glitazones are weight gain[[48]-[51]], and bone fractures in women[[52]]. The use of pioglitazone for the treatment of NAFLD is endorsed both by the NICE and AASLD guidelines, with significant limitations.
pioglitazone 37265 is endorsed both by the NICE and AASLD guidelines, with significant limitations. In the first case, pioglitazone should be prescribed only in second and third level centres, after a careful evaluation[[4]]. In the
pioglitazone 37392 prescribed only in second and third level centres, after a careful evaluation[[4]]. In the latter case, pioglitazone is reserved for patients with biopsy-proven NASH[[8]]. The EASL guidelines are more cautious, generically
pioglitazone 37534 biopsy-proven NASH[[8]]. The EASL guidelines are more cautious, generically suggesting to consider pioglitazone for the treatment of diabetes in patients with a concurrent NAFLD[[3]]. Even the Asia-Pacific and the
pioglitazone 37706 NAFLD[[3]]. Even the Asia-Pacific and the Italian guidelines acknowledge the potential benefits of pioglitazone , however, suggest that more evidence should be available before a firm recommendation can be made[[6],[7]].Vitamin
pioglitazone 38401 analysing the all-cause mortality in patients treated with t doses of > 800 IU/d[[51],[52]]. Similarly to pioglitazone , vitamin E is recommended by the NICE and AASLD guidelines (limited to biopsy-proven NASH in the latter
Select Disease Character Offset Disease Term Instance
diabetes mellitus 1294 hepatology all around the world. The widespread diffusion of metabolic risk factors such as obesity, type2- diabetes mellitus , and dyslipidemia has led to a worldwide diffusion of NAFLD. In parallel to the increased availability
diabetes mellitus 3890 bidirectional association between NAFLD and metabolic syndrome[[2]]. Obesity, insulin resistance, type 2 diabetes mellitus , and dyslipidemia are the most relevant metabolic conditions related to this spectrum of diseases[[1],[2]].Clinicians
diabetes mellitus 13480 transient elastography1"Active surveillance" (but not screening) suggested for patients with type II diabetes mellitus . EASL: European Association for the Study of the Liver; NICE: National Institute for Health and Care
diabetes mellitus 27177 three years for adults and two years for children. Moreover, children and young people with type 2 diabetes mellitus or metabolic syndrome, but without steatosis at ultrasound examination, should be reevaluated every
diabetes mellitus 33377 cirrhosis); early-stage NASH at high risk for disease progression (age > 50 years, metabolic syndrome, diabetes mellitus or increased ALT)[[41]]; active NASH with high necroinflammatory activities[[42]]. Similarly, in the
diabetes mellitus 39718 GLP-1 agonists appeared to reduce glycated haemoglobin more efficiently in Asian patients with type 2 diabetes mellitus [[55]]. On the other hand, there has been no study on Asian NASH patients, even if the pharmacokinetics
metabolic syndrome 3829 worldwide in adult and children/adolescent populations, with a bidirectional association between NAFLD and metabolic syndrome [[2]]. Obesity, insulin resistance, type 2 diabetes mellitus, and dyslipidemia are the most relevant
metabolic syndrome 14959 remains[[15]]. NICE guidelines propose to use liver ultrasound to detect hepatic steatosis for children with metabolic syndrome and type 2 diabetes and to retest it every three years if the first examination is negative[[4]].Figure
metabolic syndrome 19261 gamma-glutamyltransferase[[20]], while NAFLD liver fat score is calculated evaluating the presence/absence of metabolic syndrome and type 2 diabetes, fasting serum insulin, and aminotransferases[[21]].They have been validated in
metabolic syndrome 27198 adults and two years for children. Moreover, children and young people with type 2 diabetes mellitus or metabolic syndrome , but without steatosis at ultrasound examination, should be reevaluated every three years[[4]].Who should
metabolic syndrome 28203 NAFLD-related advanced liver disease.The AASLD guidelines suggest to perform liver biopsy in patients with metabolic syndrome who are at increased risk of liver inflammation, or when NFS, FIB-4 or liver stiffness measured by transient
metabolic syndrome 33357 (bridging fibrosis and cirrhosis); early-stage NASH at high risk for disease progression (age > 50 years, metabolic syndrome , diabetes mellitus or increased ALT)[[41]]; active NASH with high necroinflammatory activities[[42]].
obesity 1279 field of hepatology all around the world. The widespread diffusion of metabolic risk factors such as obesity , type2-diabetes mellitus, and dyslipidemia has led to a worldwide diffusion of NAFLD. In parallel to
obesity 30911 weight loss of 500-1000 g/wk with a 7%-10% total weight lossMain recommendations on diet of NICE’s obesity and preventing excess weight gain guidelines500-1000 kcal deficit1200-1600 kcal/d; fat-low (< 30% of
obesity 31237 resistance training (150-200 min/wk in 3-5 sessions)Main recommendation of on physical activity of NICE’s obesity and preventing excess weight gain guidelinesAerobic and resistance trainingAerobic and resistance trainingAerobic
obesity 42858 NASH[[8]].The Asia-Pacific recommendation limits the role of bariatric surgery only to patients with class II obesity (BMI > 32.5 kg/m2 in Asians and 35 kg/m2 in Caucasians)[[6]]. AISF and NICE guidelines do not mention
obesity 43140 common indication to liver transplantation in Western Countries[[67]]. Because of the high prevalence of obesity , sarcopenia, cardiovascular disease and chronic kidney disease among patients with NASH, there is a
obesity 43505 higher rate of primary graft non-function, and increased infectious complications, patients with severe obesity (BMI > 40 kg/m2) may even be considered unfit for liver transplantation, unless efforts are made preoperatively
type 2 diabetes mellitus 3883 a bidirectional association between NAFLD and metabolic syndrome[[2]]. Obesity, insulin resistance, type 2 diabetes mellitus , and dyslipidemia are the most relevant metabolic conditions related to this spectrum of diseases[[1],[2]].Clinicians
type 2 diabetes mellitus 27170 repeated every three years for adults and two years for children. Moreover, children and young people with type 2 diabetes mellitus or metabolic syndrome, but without steatosis at ultrasound examination, should be reevaluated every
type 2 diabetes mellitus 39711 hand, GLP-1 agonists appeared to reduce glycated haemoglobin more efficiently in Asian patients with type 2 diabetes mellitus [[55]]. On the other hand, there has been no study on Asian NASH patients, even if the pharmacokinetics

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