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eWellness: Fatty Liver

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Dr KK Aggarwal    31 March 2019

  • Fatty liver isalso called nonalcoholic fatty liver disease (NAFLD) in adults.
  • It is an ongoing silent epidemic in India.
  • NAFLD refers to the presence of hepatic steatosis when there are no other causes for secondary hepatic fat accumulation such as heavy alcohol consumption.
  • NAFLD may progress to cirrhosis and is likely an important cause of cryptogenic cirrhosis
  • NAFLD is subdivided into nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH).
  • In NAFL, hepatic steatosis is present without evidence of inflammation, whereas in NASH, hepatic steatosis is associated with hepatic inflammation that histologically is indistinguishable from alcoholic steatohepatitis
  • Risk factors for cirrhosis are, older age, diabetes, SGOT:SGPT >2 times,  BMI >28, higher visceral adiposity index, which takes into account waist circumference, BMI, triglycerides and high-density lipoprotein (HDL) level, less coffee consumption and heavy alcohol intake.
  • As little as two drinks per day in those who are overweight (and one drink per day in those who are obese) are associated with hepatic injury.
  • Liver cancer is associated with cirrhosis due to NAFLD.
  • Heart disease is the most common cause of death among patients with NAFLD.
  • Weight loss for patients who are overweight or obese is recommended.
  • Goal for many patients is to lose 0.5 to 1 kg/week (1 to 2 lb/week).
  • Vaccination for Hepatitis A and B, pneumococcal vaccination and standard immunizations (e.g., influenza, diphtheria, tetanus boosters) are recommended for the population in general.
  • Risk factors for cardiovascular disease should be managed.
  • Vitamin E at a dose of 400 IU/day may be suggested for those patients with advanced fibrosis on biopsy who do not have diabetes or coronary artery disease.
  • Avoid all alcohol consumption. Heavy alcohol use is associated with disease progression.
  • Thiazolidinediones can improve histologic parameters in patients with NASH; metformin does not.
  • UDCA has anti-inflammatory effects in the liver
  • Atorvastatin has protective effect on SGOT, SGPT levels in patients with NAFLD.
  • Pentoxifylline inhibits production of tumor necrosis factor-alpha and may be effective in NASH.
  • Omega-3 fatty acids may benefit NAFLD or NASH.
  • If serum ferritin is >1.5 times the upper limit of normal, then this indicates progressive liver disease:
  • If SGOT: SGPT > twice the upper limit of normal, then refer

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