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Nonalcoholic steatohepatitis, obesity, and cardiac dysfunction

Mathews, Sherin E.; Kumar, Rekha B.; Shukla, Alpana P.

Current Opinion in Endocrinology, Diabetes and Obesity: October 2018 - Volume 25 - Issue 5 - p 315–320
doi: 10.1097/MED.0000000000000432
OBESITY AND NUTRITION: Edited by Caroline M. Apovian

Purpose of review Obesity and nonalcoholic steatohepatitis (NASH) are epidemiologically and pathophysiologically linked disorders. Here, we summarize the effect of obesity on NASH and how it has a cascading effect on cardiovascular dysfunction. We also review the current and emerging treatment options for NASH.

Recent findings The link between NASH and cardiac dysfunction has been further delineated in recent studies demonstrating endothelial dysfunction, diastolic dysfunction, and increased coronary artery calcification in patients with known NASH. Standard treatment of obesity with lifestyle interventions including diet, exercise, and behavioral modification has been shown to improve NASH as well as reduce cardiovascular dysfunction. In addition to FDA-approved drugs like vitamin E and pioglitazone, several agents including NGM282, obeticholic acid, elafibranor, and liraglutide are currently being investigated for their therapeutic potential in NASH. Recent studies show that bariatric surgery results in significant improvement or resolution of NASH.

Summary Obesity is a major factor in the development of nonalcoholic fatty liver disease (NAFLD) and its progression to steatohepatitis. Patients with NAFLD have a significant increase in cardiovascular disease risk. For biopsy-proven NASH, vitamin E and pioglitazone are the recommended medical treatments in addition to lifestyle modification.

Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine, New York, NY, USA

Correspondence to Alpana P. Shukla, MD, MRCP (UK), Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine, 1165 York Avenue, New York, NY 10065, USA. Tel: +1 646 962 2422; e-mail: aps2004@med.cornell.edu

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