From the 2nd lecture of the Aspen Webinar. This blog entry has abbreviated/summarized this presentation. Though not intentional, some important material is likely to have been omitted; in addition, transcription errors are possible as well. This was a terrific lecture!

NASH Update Stavra Xanthakos

Key points:

• Lifestyle intervention is 1^st line Rx (especially avoiding sugary beverages, and processed foods). This may lead to resolution of NASH in ~29%, fibrosis resolution in 34%; though, only 3% resolved fatty liver
• Many have progressive disease despite lifestyle treatment recommendations
• Consider adjunctive treatments if not improving with lifestyle intervention
• Vitamin E for biopsy-confirmed disease (often for 1-2 years of therapy)
• Pioglitazone -off-label for adults (18+). Can increase weight; a lot of trials in adults
• Several phase 3 trials in NASH -GLP1 agonists promising in phase 2 trials
• GLP1 agents being used in adolescents with T2DM who may also have NASH – monitor liver outcomes
• Anti-obesity medications may help with weight and perhaps the liver. Approved agents for adolescents include 1) Orlistat -safe, but frequent side effects (eg. Diarrhea, greasy accidents) and 2) Liraglutide -daily SC.  Insurance coverage is limited.
• Biopsy is important before implementing medications and may influence decision to pursue bariatric surgery.  
• Fibroscan, if shows no significant fibrosis, can help limit biopsy.

. Related blog posts:

• Best Practice for Fatty Liver Disease | gutsandgrowth
• The Paramount Health Challenge for Humans in the 21st Century
• How Often Do Children with Obesity Have a Fatty Liver?
• Pediatric NAFLD: You Don’t Have to be Obese/Overweight to have Fatty Liver Disease (but it helps)
• Aspen Webinar 2020 (Part 6) -NAFLD and NASH
• Bariatric Surgery and Reversal of NASH in Children
• Adolescent Bariatric Outcomes
• FDA Approval of Semiglutide
• Are We On the Verge of Pharmacologic Treatment of Obesity (Again)?
• Semaglutide: Potential or Problematic New Treatment for Fatty Liver Disease/NASH
• Should We Be Excited About a New Medication (Liraglutide) for Obesity?