Abstract
Nonalcoholic fatty liver disease (NAFLD) is emerging as an important cause of liver disease in India. Epidemiological studies suggest prevalence of NAFLD in around 9% to 32% of general population in India with higher prevalence in those with overweight or obesity and those with diabetes or prediabetes. Clinicopathological studies show that NAFLD is an important cause of unexplained rise in hepatic transaminases, cryptogenic cirrhosis and cryptogenic hepatocellular carcinoma in Indian patients. There is high prevalence of insulin resistance and nearly half of Indian patients with NAFLD have evidence of full-blown metabolic syndrome. Though oxidative stress is involved in the pathogenesis of NAFLD/nonalcoholic steatohepatitis, serum or liver iron and HFE gene mutations appear not to play a role in the pathogenesis of NAFLD in Indian patients. Imaging modalities are not useful in differentiating simple steatosis from NASH and liver biopsy may be useful in those with risk factors for significant liver disease. Pilot studies on treatment strategies have shown that weight reduction and exercise, ursodeoxycholic acid, metformin, vitamin E and pentoxyfylline are effective in normalizing transaminases and or in improving hepatic steatosis and inflammation in Indian patients with NAFLD. Randomized controlled treatment trials involving large number of patients with histological end point are required to assess the efficacy of different modalities. In conclusion, a lot has been done, yet more is required to understand various aspects of NAFLD in India.
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References
Falck-Ytter Y, Younossi ZM, Marchesini G, Mc Cullough AJ. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis. 2001;21:17–26.
Ludwig J, Viggiano T, McGill D, Ott B. Nonalcoholic steatohepatitis. Mayo Clinic experience with a hitherto unnamed disease. Mayo Clin Proc. 1980;55:434–8.
Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–31.
AGA technical review on nonalcoholic fatty liver disease. Gastroenterology. 2002;123:1705–25.
Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: summary of an AASLD single topic conference. Hepatology. 2003;37:1202–19.
Misra A, Vikram NK. Insulin resistance syndrome (metabolic syndrome) and obesity in Asian Indians: evidence and implications. Nutrition. 2004;20:482–91.
Misra A, Luthra K, Vikram NK. Dyslipidemia in Asian Indians: determinants and significance. J Assoc Physicians India. 2004;52:137–42.
Ramachandran A, Snehalatha C, Satyavani K, Vijay V. Impaired fasting glucose and impaired glucose tolerance test in urban population in India. Diabet Med. 2003;20:220–4.
Duseja A, Chawla Y. Nonalcoholic fatty liver disease in India: how much? How soon? Trop Gastroenterol. 2005;26:1–3.
Singh SP, Nayak S, Swain M, et al. Prevalence of nonalcoholic fatty liver disease in coastal eastern India: a preliminary ultrasonographic survey. Indian J Gastroenterol. 2004;25:76–9.
Amarapurkar D, Kamani P, Patel N, et al. Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol. 2007;6:161–3.
Mohan V, Farooq S, Deepa M, Ravikumar R, Pitchumoni CS. Prevalence of non-alcoholic fatty liver disease in urban south Indians in relation to different grades of glucose intolerance and metabolic syndrome. Diabetes Res Clin Pract. 2009;84:84–91.
Das K, Das K, Mukherjee PS, et al. Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. Hepatology. 2010;51:1593–602.
Duseja A, Bhansali A, Bhadada S, Jain P, Dhiman RK, Chawla Y. Nonalcoholic fatty liver disease in patients with recent onset type 2 diabetes mellitus (abstract). J Gastroenterol Hepatol. 2004;19 Suppl:A402.
Gupte P, Amarapurkar D, Agal S, et al. Non alcoholic steatohepatitis in type 2 diabetes mellitus. J Gastroenterol Hepatol. 2004;19:854–8.
Banerjee S, Ghosh US, Dutta S. Clinicopathological profile of hepatic involvement in type-2 diabetes mellitus and its significance. J Assoc Physicians India. 2008;56:593–9.
Madan K, Batra Y, Panda SK, et al. Role of polymerase chain reaction and liver biopsy in the evaluation of patients with asymptomatic transaminitis: Implications in diagnostic approach. J Gastroenterol Hepatol. 2004;19:1291–9.
Dhiman RK, Duseja A. Nonalcoholic Fatty Liver Disease. In. J Assoc Physicians India. Medicine Update. Eds. Gupta SB. 2005;15:469–75.
Amarapurkar DN, Patel ND. Clinical spectrum and natural history of non-alcoholic steatohepatitis with normal alanine aminotransferases values. Trop Gastroenterol. 2004;25:130–4.
Amrapurkar D, Das HS. Chronic liver disease in diabetes mellitus. Trop Gastroenterol. 2002;23:3–5.
Duseja A, Nanda M, Das A, Das R, Bhansali A, Chawla Y. Prevalence of obesity, diabetes mellitus and hyperlipidemia in patients with cryptogenic liver cirrhosis. Trop Gastroenterol. 2004;25:15–7.
Nayak NC, Vasdev N, Saigal S, Soin AS. End-stage nonalcoholic fatty liver disease: evaluation of pathomorphologic features and relationship to cryptogenic cirrhosis from study of explant livers in a living donor liver transplant program. Hum Pathol. 2010;41:425–30.
Duseja A, Sharma BK, Kumar A, et al. Nonalcoholic fatty liver in a developing country is responsible for significant liver disease. Hepatology. 2010;52:2248–9.
Tilg H, Diehl AM. Cytokines in alcoholic and nonalcoholic steatohepatitis. N Engl J Med. 2000;343:1467–76.
Duseja A, Murlidharan R, Bhansali A, et al. Assessment of insulin resistance and effect of metformin in nonalcoholic steatohepatitis—a preliminary report. Indian J Gastroenterol. 2004;23:12–5.
Duseja A, Das A, Das R, et al. Clinicopathological profile of Indian patients with nonalcoholic fatty liver disease is different from that in the west. Dig Dis Sci. 2007;52:2368–74.
Duseja A, Das A, Dhiman RK, et al. Indian patients with nonalcoholic fatty liver disease presenting with raised transaminases are different at presentation. World J Gastroenterol. 2007;13:649–50.
Madan K, Batra Y, Gupta SD, et al. Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians. World J Gastroenterol. 2006;12:3400–5.
Amarapurkar DN, Patel ND. Prevalence of metabolic syndrome in non-diabetic and non-cirrhotic patients with non-alcoholic steatohepatitis. Trop Gastroenterol. 2004;25:125–9.
Sreenivasa Baba C, Alexander G, Kalyani B, et al. Effect of exercise and dietary modification on serum aminotransferase levels in patients with nonalcoholic steatohepatitis. J Gastroenterol Hepatol. 2006;21(1 Pt 1):191–8.
Duseja A, Thumburu KK, Das A, et al. Insulin tolerance test is comparable to homeostasis model assessment for insulin resistance in patients with nonalcoholic fatty liver disease. Indian J Gastroenterol. 2007;26:170–3.
Bajaj S, Nigam P, Luthra A, et al. A case-control study on insulin resistance, metabolic co-variates and prediction score in non-alcoholic fatty liver disease. Indian J Med Res. 2009;129:285–92.
Willett WC, Dietz WH, Colditz GA. Guidelines for healthy weight. N Engl J Med. 1999;341:427–34.
Amarapurkar DN, Amarapurkar AD. Nonalcoholic steatohepatitis: clinicopathological profile. J Assoc Physicians India. 2000;48:311–3.
Agarwal SR, Malhotra V, Sakhuja P, Sarin SK. Clinical, biochemical and histological profile of nonalcoholic steatohepatitis. Indian J Gastroenterol. 2001;20:183–6.
Steering Committee of the Western Pacific region of the World Health Organization. The International Association for the study of Obesity and the International Study Task Force. The Asia-Pacific perspective; redefining obesity and its treatment. Health Communications, Australia. 2000; 8–56.
Dudeja V, Misra A, Pandey RM, Devina G, Kumar G, Vikram NK. BMI does not accurately predict overweight in Asian Indians in northern India. Br J Nutr. 2001;86:105–12.
Deurenberg-Yap M, Chew SK, Deurenberg P. Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and Indians. Obes Rev. 2002;3:209–15.
Misra A, Misra R. Asian Indians and insulin resistance syndrome: global perspective. Metab Syndr Relat Disord. 2003;1:277–83.
Ko GT, Chan JC, Cockram CS, Woo J. Prediction of hypertension, diabetes, dyslipidaemia or albuminuria using simple anthropometric indexes in Hong Kong Chinese. Int J Obes Relat Metab Disord. 1999;23:1136–42.
Dhiman RK, Duseja A, Chawla Y. Asians need different criteria for defining obesity. Arch Intern Med. 2005;165:1069–70.
Misra A, Chowbey P, Makkar BM, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163–70.
Misra A, Vikram NK. Clinical and pathophysiological consequences of abdominal adiposity and abdominal adipose tissue depots. Nutrition. 2003;19:457–66.
Madan K, Bhardwaj P, Thareja S, Gupta SD, Saraya A. Oxidant stress and antioxidant status among patients with nonalcoholic fatty liver disease (NAFLD). J Clin Gastroenterol. 2006;40:930–5.
Bhardwaj P, Madan K, Thareja S, Joshi YK, Saraya A. Comparative redox status in alcoholic liver disease and nonalcoholic fatty liver disease. Hepatol Int. 2008;2:202–8.
Narasimhan S, Gokulakrishnan K, Sampathkumar R, et al. Oxidative stress is independently associated with non-alcoholic fatty liver disease (NAFLD) in subjects with and without type 2 diabetes. Clin Biochem. 2010;43:815–21.
Das KS, Balakrishnan V, Mukherjee S, Vasudevan DM. Evaluation of blood oxidative stress-related parameters in alcoholic liver disease and non-alcoholic fatty liver disease. Scand J Clin Lab Invest. 2008;68:323–34.
Duseja A, Das R, Das A, Dhiman RK, Chawla Y, Garewal G. Serum iron and hepatic iron overload in patients with nonalcoholic steatohepatitis. Dig Dis Sci. 2006;51:1730–1.
Duseja A, Das R, Nanda M, Das A, Garewal G, Chawla Y. Nonalcoholic steatohepatitis in Asian Indians is neither associated with iron overload nor with HFE gene mutations. World J Gastroenterol. 2005;21:393–5.
Sharma R, Sinha S, Danishad KA, et al. Investigation of hepatic gluconeogenesis pathway in non-diabetic Asian Indians with non-alcoholic fatty liver disease using in vivo ((31)P) phosphorus magnetic resonance spectroscopy. Atherosclerosis. 2009;203:291–7.
Nagarajan P, Venkatesan R, Kumar M, Usmani A, Majumdar SS. Macaca radiata (bonnet monkey): a spontaneous model of nonalcoholic fatty liver disease. Liver Int. 2008;28:856–64.
Duseja A, Das A, Das R, Dhiman RK, Chawla Y, Bhansali A. Unconjugated hyperbilirubinemia in nonalcoholic steatohepatitis—is it Gilbert’s syndrome? Trop Gastroenterol. 2005;26:123–5.
Kalra N, Duseja A, Das A, et al. Chemical shift magnetic resonance imaging is helpful in detecting hepatic steatosis but not fibrosisin patients with nonalcoholic fatty liver disease (NAFLD). Ann Hepatol. 2009;8:21–5.
Vasdev N, Kakati AG, Saigal S, Nayak NC. Spectrum of histological features in non-alcoholic fatty liver disease. Natl Med J India. 2007;20:282–7.
Singh DK, Sakhuja P, Malhotra V, Gondal R, Sarin SK. Independent predictors of steatohepatitis and fibrosis in Asian Indian patients with non-alcoholic steatohepatitis. Dig Dis Sci. 2008;53:1967–76.
Musso G, Gambino R, Cassader M, Pagano G. A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease. Hepatology. 2010;52:79–104.
Duseja A, Das A, Dhiman RK, et al. Metformin is effective in achieving biochemical response in patients with nonalcoholic fatty liver disease (NAFLD) not responding to lifestyle interventions. Ann Hepatol. 2007;6:222–6.
Madan K, Batra Y, Gupta DS, et al. Vitamin E-based therapy is effective in ameliorating transaminasemia in nonalcoholic fatty liver disease. Indian J Gastroenterol. 2005;24:251–5.
Satapathy SK, Garg S, Chauhan R, et al. Beneficial affects of tumor necrosis factor-alfa inhibition by pentoxifylline on clinical, biochemical, and metabolic parameters of patients with nonalcoholic steatohepatitis. Am J Gastroenterol. 2004;99:1946–52.
Satapathy SK, Sakhuja P, Malhotra V, Sharma BC, Sarin SK. Beneficial effects of pentoxifylline on hepatic steatosis, fibrosis and necroinflammation in patients with non-alcoholic steatohepatitis. J Gastroenterol Hepatol. 2007;22:634–8.
Sanal MG. Adipose tissue transplantation may be a potential treatment for diabetes, atherosclerosis and nonalcoholic steatohepatitis. Med Hypotheses. 2009;72:247–9.
Petersen KF, Dufour S, Feng J, et al. Increased prevalence of insulin resistance and nonalcoholic fatty liver disease in Asian-Indian men. Proc Natl Acad Sci USA. 2006;103:18273–7.
Duseja A. Nonalcoholic fatty liver disease in India—is it different? Trop Gastroenterol. 2006;27:142–6.
Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ. Asia-Pacific Working Party on NAFLD. How common is non-alcoholic fatty liver disease in the Asia-Pacific region and are there local differences? J Gastroenterol Hepatol. 2007;22:788–93.
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Duseja, A. Nonalcoholic fatty liver disease in India – a lot done, yet more required!. Indian J Gastroenterol 29, 217–225 (2010). https://doi.org/10.1007/s12664-010-0069-1
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DOI: https://doi.org/10.1007/s12664-010-0069-1