Metformin proved useful in the treatment of nonalcoholic fatty liver disease, but its superiority over nutritional treatment and antioxidants has never been demonstrated.
Dr Marchesini and colleagues aimed to compare the usefulness of metformin versus prescriptive diet or vitamin E.
The researchers conducted a randomized trial where 55 nondiabetic nonalcoholic fatty liver disease patients were given 2g/d metformin for 12 months.
The team gave 28 control cases either 800 IU/day vitamin E or a prescriptive, weight-reducing diet.
Outcome measures were liver enzymes, insulin resistance using a homeostasis model assessment, parameters of the metabolic syndrome, and histology.
| Metformin treatment was associated with higher rates of aminotransferase normalization|
|American Journal of Gastroenterology|
The investigators showed that aminotransferase levels improved in all groups, in association with weight loss.
The team found that the effects in the metformin arm were larger, and alanine aminotransferase normalized in 56 % of cases.
In multivariate analysis, metformin treatment was associated with higher rates of aminotransferase normalization, after correction for age, gender, basal aminotransferases, and change in body mass index.
The research team noted that differences were maintained when the 2 control groups were separately analyzed.
The distribution of positive criteria for the metabolic syndrome was reduced only in the metformin arm.
The team observed that a control biopsy in 17 metformin treated cases and14 nonresponders showed a significant decrease in liver fat, necroinflammation and fibrosis.
No side effects were observed during metformin treatment.
Dr Marchesini’s team concluded, “Metformin treatment is better than a prescriptive diet or vitamin E in the therapy of nonalcoholic fatty liver disease patients receiving nutritional counseling.”
”Limited histological data support an association between improved aminotransferases and biopsy findings.”
“Confirmation is required in a double-blind trial with appropriate statistical power based on liver histology.”