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PROF .DRRAM,HIV /AIDS,HEPATITIS ,SEX DISEASES & WEAKNESS expert,New Delhi,India,,+917838059592,+919832025033,ON WHATSAPP

• Fatty liver is also 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) 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. 
• 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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