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      Obesity and nonalcoholic fatty liver disease: From pathophysiology to therapeutics.

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          Abstract

          The obesity epidemic is closely associated with the rising prevalence and severity of nonalcoholic fatty liver disease (NAFLD): obesity has been linked not only with simple steatosis (SS), but also with advanced disease, i.e., nonalcoholic steatohepatitis (NASH), NASH-related cirrhosis and hepatocellular carcinoma. As a consequence, apart from increasing all-cause mortality, obesity seems to increase liver-specific mortality in NAFLD patients. Given the lack of approved pharmacological interventions for NAFLD, targeting obesity is a rational option for its management. As the first step, lifestyle modification (diet and exercise) is recommended, although it is difficult to achieve and sustain. When the first step fails, adding pharmacotherapy is recommended. Several anti-obesity medications have been investigated in NAFLD (e.g., orlistat, glucagon-like peptide-1 analogs), other anti-obesity medications have not been investigated (e.g., lorcaserin, phentermine hydrochloric, phentermine/topiramate and naltrexone/bupropion), whereas some medications with weight-lowering efficacy have not been approved for obesity (e.g., sodium-glucose cotransporter-2 inhibitors, farnesoid X receptor ligands). If the combination of lifestyle modification and pharmacotherapy also fails, then bariatric surgery should be considered in selected morbidly obese individuals. This review summarizes best evidence linking obesity with NAFLD and presents related therapeutic options.

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          Author and article information

          Journal
          Metab. Clin. Exp.
          Metabolism: clinical and experimental
          Elsevier BV
          1532-8600
          0026-0495
          Mar 2019
          : 92
          Affiliations
          [1 ] First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: spolyzos@auth.gr.
          [2 ] Second Medical Clinic, Medical School, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece.
          [3 ] Section of Endocrinology, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA.
          Article
          S0026-0495(18)30253-1
          10.1016/j.metabol.2018.11.014
          30502373
          2ee72c9f-7151-4aff-9941-d7746ad89b4d
          History

          Metabolic syndrome,Nonalcoholic fatty liver disease,Nonalcoholic steatohepatitis,Obesity,Treatment,Adipose tissue

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