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Dr K K Aggarwal

Fatty Liver

By Dr K K Aggarwal
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  • 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

Treatment of fatty liver

By Dr K K Aggarwal
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  1. A 10% weight loss can improve fatty liver and possibly inflammation.
  2. Metformin and ursodeoxycholic acid (UDCA) are not recommended.
  3. Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
  4. Omega-3 fatty acids have been tried.
  5. Pioglitazone is useful in the treatment of biopsy-proven fatty liver with inflammation.
  6. Vitamin E at a dose of 800 IU/day improves liver inflammation
  7. Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.

Beware of fatty liver

By Dr K K Aggarwal
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  1. Nonalcoholic fatty liver disease (NAFLD) means presence of hepatic steatosis (fatty liver), when no other causes for secondary hepatic fat accumulation (heavy alcohol consumption) are present.
  2. NAFLD, if not treated, may progress to cirrhosis and is likely an important cause of cryptogenic cirrhosis.
  3. NAFLD is subdivided into: Nonalcoholic fatty liver (NAFL) or simple fatty liver with no liver inflammation and nonalcoholic steatohepatitis (NASH) or fatty liver with liver inflammation
  4. Patients with NAFLD may have mild or moderate elevations in SGOT and SGPT levels (liver enzymes).
  5. Normal SGOT and SGPT levels, however, do not exclude NAFLD.
  6. When elevated, the SGOT and SGPT levels are typically 2 to 5 times the upper limit of normal.
  7. In acute viral hepatitis, the SGOT/SGPT ratio is less than 1 (unlike alcoholic fatty liver disease, which typically has a ratio greater than 2)
  8. The degree of SGOT and SGPT elevation does not predict the degree of liver inflammation or fibrosis, and a normal SGOT, SGPT levels does not exclude clinically important histologic injury.
  9. The alkaline phosphatase may be elevated to 2 to 3 times the upper limit of normal.
  10. Serum albumin and bilirubin levels are typically within the normal range, but may be abnormal in patients who have developed cirrhosis. When cirrhosis sets in, one may have prolonged prothrombin time and cytopenias.
  11. A serum ferritin greater than 1.5 times the upper limit of normal in patients with NAFLD may mean presence of inflammation

Traditionally, we recognize Raksha Bandhan as a bond of love between a brother and a sister. Rakhi is synonymous with purity of the relationship. The tying of the rakhi also denotes the brother’s vow to protect his sister. The Raksha Bandhan festival represents the spirit of fraternity. It is a traditional way to celebrate the unconditional love between siblings. The word ‘Raksha’ means protection and ‘Bandhan’ signifies bondage. Rakhi is a sacred that sister ties on her brother’s wrist to protect him from all types of negativity in life. The brother also vows to protect his loving sister by offering her a suitable gift. This festival that glorifies precious emotions of love, care and affection Give your sister the precious gift of good health on this Raksha Bandhan. Gift her a health checkup package. Share love not sweets. Sweets are rich in trans-fats and refined carbohydrates. Trans-fats increase LDL or the bad cholesterol and lower HDL or the healthy cholesterol and increase the risk for diseases like heart attack. Sweets that are made of hydrogenated fats are rich in trans-fats. Also, do not gift chocolates as they are rich in refined sugar and saturated fats. They can be harmful to the health. Chocolates can increase the chances of fatty liver, abdominal obesity and metabolic syndrome. Give dry fruits, jaggery chana, sattu, fruits instead of sweets, chocolates and cookies. All women needs iron an proteins. Jaggery is high in iron and chana (black gram) in proteins. Sattu is the natural healthy fast food and good for the health. Fresh fruits are health friendly. One should eat atleast 3-5 servings of fruits every day, Dry fruits are protective as they have high contents of natural vitamin E. The views and opinions expressed in the text are entirely my personal views.

Treatment of Fatty Liver

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , | | Comments Off on Treatment of Fatty Liver

  • A 10% weight loss can improve fatty liver and possibly inflammation.
  • Metformin and ursodeoxycholic acid (UDCA) are not recommended.
  • Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
  • Omega–3 fatty acids have been tried
  • Pioglitazone is useful in the treatment of biopsy–proven fatty liver with inflammation
  • Vitamin E at a dose of 800 IU/day improves liver inflammation
  • Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.

Treatment of Fatty Liver

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , | | Comments Off on Treatment of Fatty Liver

  • A 10% weight loss can improve fatty liver and possibly inflammation.
  • Metformin and ursodeoxycholic acid (UDCA) are not recommended.
  • Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
  • Omega–3 fatty acids have been tried
  • Pioglitazone is useful in the treatment of biopsy–proven fatty liver with inflammation
  • Vitamin E at a dose of 800 IU/day improves liver inflammation
  • Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.

Treatment of Fatty Liver

By
Filed Under Wellness | Tagged With: , , , | | Comments Off on Treatment of Fatty Liver

• 10 % weight loss can improve fatty liver and possibly inflammation.
• Metformin and ursodeoxycholic acid are not recommended.
• Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
• Omega-3 fatty acids have been tried
• Pioglitazone is useful in the treatment of biopsy-proven fatty liver with inflammation
• Vitamin E at a dose of 800 IU/day improves liver inflammation
• Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.