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Insulin Sensitisers in the Treatment of Non-Alcoholic Fatty Liver Disease: A Systematic Review

Insulin Sensitisers in the Treatment of Non-Alcoholic Fatty Liver Disease: A Systematic Review

Health Technology Assessment - NIHR Evaluation, Trials and Studies Coordinating Centre (UK)

Version: November 2011

Executive summary

Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of disease, ranging from an increased fat content in the liver (steatosis) to inflammatory change (non-alcoholic steatohepatitis – NASH), and potentially to fibrosis and cirrhosis. By definition, it is seen in people whose alcohol intake is not increased (such as < 10 g a day for women, < 20 g a day for men).


NAFLD in its various stages is becoming more common and is an increasing health problem, because of the rising prevalence of obesity and insulin resistance.

Clinical effectiveness

Systematic reviews and RCTs. There was no size restriction on the number of patients in trials, as those with inadequate numbers, and hence power, might be useful when combined in a meta-analysis. Observational studies were considered for data on safety.

Review of economics studies

The search strategy used is in Appendix 1.


‘Non-alcoholic fatty liver disease’ (NAFLD) is a term used for a group of inter-related chronic liver disorders causing a wide spectrum of liver damage associated with increased fat content in the liver in the absence of increased alcohol intake [< 10 g of alcohol per day for women, < 20 g per day for men (around 9–18 units of alcohol per week, respectively)]., By definition, to have NAFLD, > 5% of the liver weight must be due to accumulation of fat. NAFLD has become recognised as an important problem only recently and was relatively unknown prior to 1980., Population-based screening studies suggest that the prevalence of NAFLD is in the region of 17–33% in the Western world. The prevalence of non-alcoholic steatohepatitis (NASH) is not known because it currently requires a liver biopsy to confirm the diagnosis, but it has been estimated to be around 3% in the total population.

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