Non-alcoholic Fatty Liver Disease and Metabolic Syndrome-Position Paper of the Indian National Association for the Study of the Liver, Endocrine Society of India, Indian College of Cardiology and Indian Society of Gastroenterology.
Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome. Prevalence of metabolic risk factors including diabetes mellitus, obesity, etc. is rapidly increasing in India putting this population at risk for NAFLD. Patients with NAFLD are at increased risk for liver-related morbidity and mortality and also cardiovascular disease risk and increased incidence of diabetes mellitus on long-term follow-up. Management of patients with NAFLD may require a multi-disciplinary approach involving not only the hepatologists but also the internists, cardiologists, and endocrinologists. This position paper which is a combined effort of the Indian National Association for Study of the Liver (INASL), Endocrine Society of India (ESI), Indian College of Cardiology (ICC) and the Indian Society of Gastroenterology (ISG) defines the spectrum of NAFLD and the association of NAFLD with insulin resistance and metabolic syndrome besides suggesting preferred approaches for the diagnosis and management of patients with NAFLD in the Indian context.
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Ajay
A
Duseja
Department of Gastroenterology, SCB Medical College, Cuttack, Odisha, India.
Shivaram P
SP
Singh
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Vivek A
VA
Saraswat
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Subrat K
SK
Acharya
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Yogesh K
YK
Chawla
Department of Endocrinology, Institute of Postgraduate Medical Education & Research and SSKM Hospital, Kolkata, West Bengal, India.
Subhankar
S
Chowdhury
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Radha K
RK
Dhiman
Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Rohinivilasam V
RV
Jayakumar
Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Gurgaon, Haryana, India.
Kaushal
K
Madan
Department of Gastroenterology, MotiLal Nehru Medical College, Allahabad, Uttar Pradesh, India.
Sri P
SP
Misra
Department of Cardiology, SCB Medical College, Cuttack, Odisha, India.
Hrudananda
H
Mishra
Department of Cardiology, Indraprastha Apollo Hospital, New Delhi, India.
Sunil K
SK
Modi
The Tamil Nadu Dr. M.G.R. Medical University & AG Hospital, Tirupur, Tamil Nadu, India.
Arumugam
A
Muruganathan
Department of Endocrinology, Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India.
Banshi
B
Saboo
Osmania Medical College & Osmania General Hospital, Hyderabad, Andhra Pradesh & MediCiti Hospital, Hyderabad, Andhra Pradesh, India.
Rakesh
R
Sahay
Department of Gastroenterology, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India.
Rajesh
R
Upadhyay
ALT, Alanine Aminotransferase; APO C3, Apolipoprotein C3; ARFI, Acoustic Radiation Forced Impulse; AST, Aspartate Aminotransferase; ATPIII, Adult Treatment Panel III; BMI, Body mass index; CAD, Coronary artery disease; CC, Cryptogenic Cirrhosis; CIMT, Carotid Intima Media Thickness; CK 18, Cytokeratin 18; CT, Computed Tomography; DM, Diabetes Mellitus; EBP, Enhancer-Binding Protein; EMA, Anti-Endomysial antibodies; FFA, Free Fatty Acids; FMD, Flow-Mediated Vasodilatation; FPG, Fasting Plasma Glucose; GTT, Glucose Tolerance Test; HCC, Hepatocellular Carcinoma; HOMA-IR, Homeostasis Model Assessment for Insulin Resistance; HTG, Hepatic triglyceride; HTN, Hypertension; IFG, Impaired Fasting Glucose; IGT, Impaired Glucose Tolerance; IKK-β, Inhibitor of nuclear factor kappa-B kinase beta; IR, Insulin resistance; IRS-1, Insulin Receptor Substrate-1; ITT, Insulin Tolerance Test; LFTs, Liver Function Tests; MRE, Magnetic Resonance Elastography; MS, Metabolic syndrome; NAFLD; NAFLD, Non-alcoholic fatty liver disease; NASH; NASH, Non-Alcoholic Steatohepatitis; NF-κβ, Nuclear Factor Kappa Β; PCOS, Polycystic Ovarian Syndrome; PPG, Post-Prandial Glucose; PROCAM, Prospective Cardiovascular Munster study; SREBP, Sterol-Regulatory Element-Binding Protein; T2DM, Type 2 Diabetes Mellitus; TE, Transient elastography; TG, Triglycerides; TTG, Anti-tissue transglutaminase; VHCC, Virus-related HCC; VLDL, Very Low Density Lipoprotein; WHO, World Health Organization; cryptogenic cirrhosis; insulin resistance; nonalcoholic steatohepatitis