Written and reviewed by
C.S.C, D.C.H, M.B.B.S
General Physician, Alappuzha
It is also called nonalcoholic fatty liver disease in adults.
It is an ongoing silent epidemic in India.
Nonalcoholic fatty liver disease (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 NAFLD, 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 level, less coffee consumption, 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) is associated in 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 among patients with NAFLD.
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 >1.5 times the upper limit of normal: Progressive liver disease:
If SGOT:SGPT > twice the upper limit of normal, then refer
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