Background: We recently examined the distribution of abdominal fat, dietary intake and biochemical data in patients with nonalcoholic fatty liver disease (NAFLD) and compared these factors between nonobese and obese individuals. We found that non-obese NAFLD patients did not necessarily exhibit insulin resistance and/or dysregulated secretion of adipocytokines. However, the dietary cholesterol intake was superabundant and the dietary intake of polyunsaturated fatty acids was significantly lower in non-obese patients compared with obese patients, although total energy and carbohydrate intake was not excessive. Therefore, surplus cholesterol intake appears to be a factor associated with NAFLD development and liver injury.
Case Report: In a non-obese 48-year-old male patient with NAFLD, in whom ursodeoxycholic acid and tocopherol acetate treatments were not effective, we tested a novel approach using the cholesterol absorption inhibitor ezetimibe. Without any dietary or exercise modifi cation, 10 mg/day of ezetimibe was started instead of tocopherol acetate. Although body weight and body mass index remained nearly constant, the serum levels of transaminases promptly decreased into the normal range, which was accompanied by a decrease in serum total cholesterol and LDL-cholesterol exceeding 10%.
Conclusions: Ezetimibe may offer a novel treatment for NAFLD, particularly in non-obese patients.

Keywords: ezetimibe, Nonalcoholic fatty liver disease, Cholesterol