**2.4 DHEA as a candidate for the treatment of NASH**

There is no specific established treatment for NASH. Management of NASH consists of lifestyle modification including a healthy diet and physical exercise. DHEA has been widely touted as an anti-aging supplement. For years DHEA was promoted as a miracle weight loss drug, based upon some rodent studies that indicated DHEA was effective in controlling obesity in rats and mice. Other rodent studies found similar promising results for DHEA in preventing cancer, arteriosclerosis and diabetes. A randomized, double-blind, placebocontrolled trial showed that DHEA replacement therapy significantly decreases not only in visceral fat area and subcutaneous fat area, but also in insulin resistance. (Villareal & Holloszy, 2004). In contrast, DHEA replacement has no detectable effect on body composition, physical performance, insulin action, or quality of life (Nair et al., 2006). Therapeutic benefits of hormone supplementation for the treatment of aging, insulin resistance and cardiovascular disease remain obscure and controversial. DHEA can cause higher than normal levels of androgens and estrogens in the body, and theoretically may increase the risk of prostate, breast, ovarian, and other hormone-sensitive cancers. A protective effect of DHEA was reported in an orotic acid-induced animal model of fatty liver disease (Goto et al., 1998). Since the clinical usefulness of DHEA for NAFLD patients has never been investigated, there is a great need for prospective, randomized, multicenter and well-designed trials.
