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The important role of hyperinsulinaemia and fatty ratty insulin resistance as major pathogenic factors in NAFLD support the use of insulin sensitising agents. The addition of metformin to a restricted diet reduces fatty ratty insulin resistance. Thiazolidinediones have been shown to improve insulin sensitivity and aminotransferase levels. They also reduce liver size, hepatic fat content and improve histology results. Two new treatments have been tested. Losartan has been shown to reduce blood markers of hepatic fibrosis, plasma transforming growth factor- b 1 (TGF- b 1), ferritin and aminotransferase levels. Pentoxifylline is a methylxanthine fatty ratty compound inhibiting the production of cytokines (mainly TNF- a and TGF- b involved in the pathogenesis of NASH.
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