Objectives Non alcoholic fatty liver disease (NAFLD) is the most common cause of elevated liver enzymesin developed countries. This condition is characterised by insulin resistance,hepatic steatosis, and frequently diabetes mellitus type 2. The dyslipidemia in NAFLD characterised by increased in very-low-density lipoprotein (VLDL), triglycerides (TG), and low high-density lipoprotein cholesterol (HDL-C).

Methods We report a clinical case of a 67-year-oldman with type 2 diabetes mellitus and dyslipidemia for 2 years. His weight was 74.2 kg with BMI 26.21 kg/m². He was asymptomatic and undergo abdominal ultrasound 6 month ago for suspect of urolithiasis and his liver ultrasound showed a fatty infiltration, he was then referred to hepatologist regarding his condition. The initial investigations include laboratory data that showed total bilirubin of 0.6 mg/dL, IU/L alkaline phosphates of 97 mg/dL, albumin 4.6 mg/dL, fasting value for glucose of 270 mg/dL, A1c 6.1%, triglycerides of 157 mg/dL and slight elevation of aminotransferase ALT 47 U/L and AST 52 U/L (ALT and AST ratio: 0.9). Serologic markers for viral hepatitis have been negative. There is no history of alcohol consumption, past liver condition, nor family history of liver disease. There were no pathologic findings at the physical examination. We treat this patient with Metformin 3 x 500 mg, Glicuidone 2 x 60 mg, statin 1 x 10 mg, vitamin E 1 x 1 and followed a restricted diet and practice exercise for 20 weeks.

Results Outcome after combination therapy of pharmacology, diet, and exercise was good, and hisliver enzyme was down to AST 25 U/L and ALT 37 U/L.

Conclusions A comprehensive and aggressive treatments in both pharmacology and non pharmacology are needed to reduce cardiovascular and metabolic syndrome morbidity from this case, thus improves the quality of life of patients with fatty liver diseases.