Approach to the Patient with Nonalcoholic Fatty Liver Disease.

NASH is reversible with treatment of obesity, calling for a broader use of structured weight-loss programs, obesity pharmacotherapy and bariatric surgery. While no drugs are FDA-approved for the treatment of NASH, diabetes medications such as pioglitazone and some glucagon-like peptide 1 receptor agonists, improve liver histology and cardiometabolic health. Sodium-glucose cotransporter-2 inhibitors and insulin may ameliorate steatosis, but their effect on steatohepatitis and fibrosis remains unclear. Awareness by endocrinologists about which are the high-risk groups, establishing an early diagnosis of fibrosis (i.e., FIB-4, liver elastography), long-term monitoring, and timely referral to the hepatologist within the care of a multidisciplinary team are all critical to curve the looming epidemic of cirrhosis from NAFLD upon us.