Non-alcoholic fatty liver disease (NAFLD) is a widely prevalent disease characterized by hepatic manifestation of the metabolic syndrome. Affected patients often suffer from various comorbidities, like obesity, impaired glucose tolerance, type 2 diabetes, hyperlipidemia and hypertension. The complex of these conditions is likely to enhance the risk of cardiovascular diseases and may contribute to the progression of hepatic damage. Thus, the approach to treatment of NAFLD targets metabolic derangements, all associated with insulin resistance. With regard to this, use of metformin, an insulin sensitizing agent seems to be beneficial in diabetic as well as non-diabetic patients, when prescribed along with hypocaloric diet and weight loss advice.¹

Metformin may help in ameliorating many components of metabolic syndrome. In diabetic patients, it can also provide cardiovascular protection due to its antihyperglycemic effectsas well asits favorable actions on lipid metabolism, vascular smooth-muscle and cardiomyocyte intracellular calcium handling, hypercoagulation, and platelet hyperactivity. In addition, it may cause significant antihypertensive effects, including both insulin-dependent and insulin-independent vasodilatory actions and probably central antihypertensive effects. Besides, some studies have shown its efficacy in improving lipoprotein profiles, reducing markers of inflammation, decreasing hypercoagulation, increasing fibrinolysis, and reducing circulating advanced glycated end products, which are oxidative mediators of endothelial dysfunction.¹

Information available from various studies support the role of metformin in patients with NAFLD.^1,2 A prospective randomized study assessed the efficacy of adding metformin to dietary treatment in 50 obese and nondiabetic patients. The results showed an improvement or even disappearance of hepatic steatosis similar to that seen with diet treatment alone. Use of metformin remarkably improved many metabolic parameters (increased insulin sensitivity and reduced fasting glucose) than diet alone. It is noteworthy that differences in fasting glucose (from 92.4 ± 9.9 to 89.1 ± 9.3 mg/dL) and HOMA-IR index (from 3.3 ± 1.6 to 2.4 ± 1.2, ) attained statistical significance only in the metformin group.² Furthermore, outcomes of metformin in pediatric patients have also been favorable, especially in terms of biochemistry liver profile and metabolic parameters. Therefore, current evidences suggest a pivotal role of metformin in patients with NAFLD.¹

References

1. The Role of Metformin in the Management of NAFLD.Available at: https://www.hindawi.com/journals/jdr/2012/716404/ Accessed on 2 Dec 2020
2. Garinis GA, Fruci B, Mazza A, et al.Metformin versus dietary treatment in nonalcoholic hepatic steatosis: a randomized study. International Journal of Obesity. 2010;34(8):1255–1264.