Schematic representation of NAFDL diagnosis and management. No consensus is available for the use of insulin sensitizers (metformin and pioglitazone), although studies have generally shown beneficial effects. The US Food and Drug Administration (FDA) has recently released a note to inform that the use of pioglitazone for more than one year may be associated with an increased risk of bladder cancer. In France the use of pioglitazone has been suspended while in Germany it is recommended not to start pioglitazone in new patients. Scanty data are available with regard to the efficacy of statins and hepatoprotective agents. Liver ultrasonography, the most practicable method for NAFLD detection is actually used to monitor response to treatment although not yet validated. Liver function tests may be useful despite a poor sensibility for NAFLD diagnosis and disease monitoring. Metabolic parameters still represent viable indexes of response to therapy.
