The Role of Metformin in the Management of NAFLD

Table 1

Summary of metformin trials in NAFLD/NASH patients.

References	Study design	Patients	Therapy	Outcomes
Marchesini et al. [52]	OL, SA	20 patients, (OB); NASH, elevated AMTs	Metformin 1.5 g/d; 4 months	↓ ALT; ↓ IR; ↓ liver volume
Nair et al. [53]	OL, SA	28 patients, (OW/OB/T2DM); NAFLD	Metformin 20 mg/kg/d; 12 months	↓ ALT and AST; ↓ IR; Histology improved
Uygun et al. [54]	OL, RAND	36 patients, (OW/OB); NASH, elevated AMTs	Metformin 1.7 g/d + diet versus diet; 6 months	↓ IR; ↓ ALT and AST; Histology not improved
Bugianesi et al. [55]	OL, RAND (MC)	110 patients, (OW/OB/T2DM); NAFLD, elevated AMTs	Metformin 2 g/d + diet versus vit E + diet versus die; 12 months	↓ AST and ALT; Histology improved
Schwimmer et al. [63]	SA	10 patients (OB/NT2DM children); NASH, elevated AMTs	Metformin 1 g/d; 6 months	↓ AST and ALT; ↓ Liver fat; ↓ IR
Duseja et al. [56]	OL, NRAND	50 patients, (OW/OB); NAFLD, elevated AMTs	Metformin 1.5 g/d; 6 months versus diet	↓ ALT and AST; ↓ IR
Loomba et al. [47]	OL, SA	28 patients, (OW/OB/T2DM); NASH, elevated AMTs	Metformin 2 g/d; 12 months	Histology improved; ↓ ALT and AST; ↓ IR
de Oliveira et al. [57]	OL, SA	20 patients, (OW/OB/T2DM); NASH, elevated AMTs	Metformin 1 g/d; 12 months	↓ ALT; Histology improved; ↓ IR
Idilman et al. [58]	OL, RAND	74 patients, (OW/OB/T2DM); NASH, elevated AMTs	Metformin 1.7 g/d; 12 months	↓ ALT; Histology not improved; ↓ IR
Nobili et al. [65]	OL	57 patients (OW/OB children); NASH/NAFLD	Metformin 1.5 g/d versus diet; 24 months	↓ ALT and AST; ↓ IR; Histology improved
Haukeland et al. [59]	PLAC, RAND	48 patients (OW/OB/T2DM); NAFLD, elevated AMTs	Metformin versus placebo; 6 months	↓ ALT and AST; ↓ IR; Histology not improved
Nadeau et al. [64]	RAND	50 patients (OB children); NAFLD/elevated AMTs	Metformin 1.7 g/d + diet versus diet; 6 months	↓ ALT and AST; ↓ IR; Ultrasound pattern improved
Garinis et al. [35]	OL, RAND	50 patients, (OW/OB); NAFLD, normal AMTs	Metformin 1 g/d + diet versus diet; 6 months	↓ ALT and AST, ↓ IR Ultrasound pattern improved; ↑ Adiponectin

Abbreviations: ALT, alanine transaminase; AMTs, aminotransferases; AST, aspartate aminotransferase; IR, insulin resistance; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; NRAND, non randomized; NT2DM, non type 2 diabetes mellitus; OB, obese; OL, open label; OW, overweight; PLAC, placebo controlled; RAND, randomized; SA, single arm; T2DM, type 2 diabetes mellitus.