NAFLD is the hepatic manifestation of the metabolic syndrome. It is a major cause of hepatic morbidity and mortality worldwide, and in addition there is significant morbidity and mortlaity due to the complications of obesity that is usually present. It is a disease of epidemic proportion consequent to the increase in obesity worldwide. An effecticve treatment program should contain steps for prevention, dietary manipulations including a decrease in the major compnents of the urban westernized diet,an increase in physical activity and an increase in coffee consumtion.

Despite this simple and low cost intervention, there is a huge investment of resouces by the pharmaceutical industry to develop medications that reduce the degree of heaptic fibrosis. Medications under investigation includeobeticholic acid, Tropifexor, GS-9764, NGM 282, MGL-3196, VK2089, GS0976, Aramchol, Semaglutide. Other medications that are available off label include metformin, pioglitazone, exenatide,. Bariatric surgery for obesity has been found to be effective.

I will initially review the epidemiology, clinical features and the non-pharmacological therapies available. Subsequently I will review the pharmacological options avaiable or being investigated.

I suggest the allocation of resources to non-pharmacological therapies of prevention by life style changes and public health measures will have a far greater success in improving morbidity, quality of life and decreasing mortality than the billions of dollars being invested in development of pharmacological therapies that are in the main concetrating on a decrease in hepatic fibrosis as a trial end-point.

Objectives To review the optiaml treatment for NAFLD and compare to the pharmacological treatments being developed

Method Literature review

Conclusions Much more effort needs to be invested worldwide into prevention and lifestyle adjustments for this disease, rather than new medications or changing the indications for current medications.