Dear Colleague,

July 28 is World Hepatitis Day

Kindly pass on this information to your members.

Fatty Liver

  • Is also called nonalcoholic fatty liver disease in adults
  • Is an ongoing silent epidemic in India
  • Nonalcoholic fatty liver disease (NAFLD) refers to the presence of hepatic steatosis when no other causes for secondary hepatic fat accumulation (eg, heavy alcohol consumption) are present. 
  • 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 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
  • Goal for many patients is to lose 0.5 to 1 kg/week (1 to 2 lb/week). 
  • Hepatitis A and B vaccinations. Pneumococcal vaccination and standard immunizations recommended for the population in general (eg, influenza, diphtheria, tetanus boosters)
  • Treatment of risk factors for cardiovascular disease
  • Vitamin E at a dose of 400 int. unit/day for the subset of 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 has 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
  • Progressive liver disease: if serum ferritin >1.5 times the upper limit of normal 
  • SGOT SGPT > twice the upper limit of normal refer

With kind regards,

Yours sincerely,

Dr A Marthanda Pillai                                                 Dr K K Aggarwal