ABSTRACT
AIM: To summarize the evidence available for the clinical effectiveness of insulin sensitizers in the treatment of nonalcoholic fatty liver disease (NAFLD) systematically. METHODS: Relevant articles were located using computer-assisted searches of Medline (1966-March 2006), EMBASE (1988-March 2006), CINAHL (1982-March 2003), Educational Resource Information Center (1966-March 2006), Library, Information Science and Technology Abstracts (1967-March 2006), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (1994-2006), dissertations in ProQuest and FirstSearch databases. Manual searches were made in the abstracts from meetings of the American Gastroenterological Association (1999-2006), and the American Association for the Study of Liver Diseases (2003-2005). Studies were retrieved using the following selection criteria: (1) clinical trials using insulin sensitizers in subjects with NAFLD, (2) adult patients, (3) published as full manuscripts or abstracts, and (4) English, Spanish, German, and French languages only. Data were abstracted independently by two reviewers following standardized procedures. A face-to-face comparison of data was conducted to ensure the completeness and reliability of the abstraction process. RESULTS: Nine studies were included, six using metformin and three using thiazolidinediones. Only two studies were placebo-controlled trials. The median sample size for all studies was 18 subjects. In the placebo-controlled trials, metformin improved insulin resistance markers and liver function tests, but not histological scores. In the single-arm trials, metformin and thiazolidinediones improved insulin resistance markers and liver function tests, and beneficial histological changes were reported. There is limited high-quality information available from which to draw categorical conclusions about the clinical use of insulin sensitizers in NAFLD. CONCLUSION: Current information indicates that the use of insulin sensitizers in NAFLD improves insulin resistance and liver function. Histological changes must be corroborated in randomized controlled trials.
Subject(s)
Fatty Liver/drug therapy , Fatty Liver/physiopathology , Insulin/physiology , Controlled Clinical Trials as Topic , Diet, Carbohydrate-Restricted , Fatty Liver/pathology , Humans , Hypoglycemic Agents/therapeutic use , Insulin Resistance/physiology , Liver/physiopathology , Metformin/therapeutic use , Thiazolidinediones/therapeutic useABSTRACT
Se realizó un estudio exploratorio descriptivo en un grupo de pacientes obesos mayores de 15 años, escogidos al azar en los policlínicos "Héroes del MOncada" y el Docente "Lawton", para indagar los conocimientos, opiniones y criterios que el paciente tiene sobre su obesidad. Los resultados mostraron que entre el 80 y el 88 por ciento reconocían la magnitud de su exceso corporal; ambas áreas de salud tenían escasos conocimientos sobre las medidas concretas para combatir la obesidady sólo encontramos diferencia estadísticamente significativa en el antecedente de haber recibido charlas sobre la entidad y la preferencia del consumo de carbohidratos refinados y grasas entre las 2 áreas de salud, por lo que resulta evidente la necesidad de enfatizar la actividad educativa como medio para combatir y prevenir la obesidad (AU)
