International Textbook Of Diabetes Mellitus, 4th Ed., Excerpt #106: Treatment Of Nonalcoholic Fatty Liver Disease And Nonalcoholic Steatohepatitis Part 4
The role of statins in the primary and secondary prevention of CVD has been well established. Patients with NAFLD are believed to have increased cardiovascular risk [6] and are logical candidates for their long-term use. In accordance with their higher cardiovascular risk, the use of statins should be encouraged in patients with NAFLD but their use has remained controversial in such patients, particularly in the setting of elevated liver enzymes [5]. Recent practice guidelines on statin use in patients with NAFLD have clearly established that they are overall safe and that they do not carry a higher risk of liver toxicity [79,80]. In addition to their apparent safety in NAFLD, several small studies have suggested that statins may improve histology in NASH by means of their anti-inflammatory, antioxidant, or other pleiotropic properties [5]. Several studies reported that statins may decrease plasma aminotransferase concentration or hepatic steatosis by ultrasound [5,81,82]. However, it should be emphasized that these studies were overall of inadequate quality due to small sample size, uncontrolled design, short duration and/or lack of gold-standard endpoints, such as liver MRS or histology. In many of these trials effects were difficult to separate from weight loss, dietary changes or other lifestyle modifications during the study. In studies in which a liver biopsy was performed before and after statin treatment, Kimura et al. [83] (n=43) and Rallidis et al. [84] (n=5) found that liver inflammation improved, in contrast to reports from Georgescu et al. [85] (n=10) and Ekstedt et al. [86] (n=17). Beyond these discrepancies, there is agreement that hepatocyte ballooning and fibrosis do not improve with statin therapy. In the only randomized controlled trial in patients w Continue reading >>
Treatment Of Nonalcoholic Fatty Liver Disease (nafld) In Patients With Type 2 Diabetes Mellitus
Abstract Nonalcoholic fatty liver disease (NAFLD) is believed to be the most common chronic liver disease, affecting at least one-third of the population worldwide. The more aggressive form is known as nonalcoholic steatohepatitis (NASH) and characterized by hepatocyte necrosis and inflammation. The presence of fibrosis is not uncommon. Fibrosis indicates a more aggressive course and patients with NASH that are at high-risk of cirrhosis and premature mortality, as well as at increased risk of hepatocellular carcinoma (HCC). Patients with type 2 diabetes mellitus (T2DM) are at the highest risk for the development of NASH, even in the setting of normal plasma aminotransferase levels. The presence of dysfunctional adipose tissue in most overweight and obese subjects, combined with insulin resistance, hyperglycemia, and atherogenic dyslipidemia, contribute to their increased cardiovascular risk. Many therapeutic agents have been tested for the treatment of NASH but few studies have focused in patients with T2DM. At the present moment, the only FDA-approved agents that in controlled studies have shown to significantly improve liver histology in patients with diabetes are pioglitazone and liraglutide. Current research efforts are centering on the mechanisms for intrahepatic triglyceride accumulation and for the development of steatohepatitis, the role of mitochondrial dysfunction in NASH, and the impact of improving glycemic control per se on the natural history of the disease. This brief review summarizes our current knowledge on the pharmacological agents available for the treatment of NASH to assist healthcare providers in the management of these challenging patients. Keywords Nonalcoholic fatty liver disease (NAFLD)Nonalcoholic steatohepatitis (NASH)Type 2 diabetes mellit Continue reading >>
The Relationship Between Diabetes Mellitus, Cirrhosis, And Hepatocellular Carcinoma In Patients With Fatty Liver Disease
The Relationship between Diabetes Mellitus, Cirrhosis, and Hepatocellular Carcinoma in Patients with Fatty Liver Disease Diabetes mellitus is an independent predictor of cirrhosis and hepatocellular carcinoma (HCC) among patients with fatty liver disease, according to study results presented by lead author Evan Raff, MD, of the department of Internal Medicine, University of Alabama at Birmingham, during a poster session at the 2013 American College of Gastroenterology in San Diego, CA. Diabetes mellitus is among the risk factors for chronic liver disease, along with infection with hepatitis B or C virus, heavy alcohol consumption, and nonalcoholic fatty liver disease. In this retrospective study, to explore the relationship between diabetes and the progression of steatohepatitis, also known as fatty liver disease, researchers looked at medical charts from 2007 to 2011 of patients whose steatohepatitis-related disease was managed at a single tertiary center. The data review included demographics; comorbidities including diabetes mellitus, cirrhosis and complications, and hepatocellular carcinoma; and laboratory, imaging and histology. Other causes of liver disease and excess history of alcohol use were excluded in diagnosis. Patients with and without diabetes mellitus were compared using chi-square and t-tests for categorical and continuous variables, respectively. Independent association of diabetes mellitus with cirrhosis and hepatocellular carcinoma were examined using a logistic regression model and data were reported as an odds ratio with a 95 percent confidence interval. Among the 503 patients with steatohepatitis, 276 had nonalcoholic steatohepatitis. Patients with diabetes compared to those without were more often female, obese, consumed less than one alcoholic Continue reading >>
Diabetes Mellitus, Insulin, Sulfonylurea And Advanced Fibrosis In Non-alcoholic Fatty Liver Disease
Received date: June 27, 2014; Accepted date: July 26, 2014; Published date: August 03, 2014 Citation: Goh GBB, Pagadala MR, Dasarathy J, Unalp-Arida A, Sargent R, et al. (2014) Diabetes Mellitus, Insulin, Sulfonylurea and Advanced Fibrosis in Non-Alcoholic Fatty Liver Disease. J Diabetes Metab 5:410 doi: 10.4172/2155-6156.1000410 Copyright: 2014 Goh GBB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background & aims: Diabetes mellitus is a risk factor for advanced fibrosis in non-alcoholic fatty liver disease. However, not all non-alcoholic fatty liver disease patients with diabetes develop advanced fibrosis . We hypothesised that prescription medications used by these patients influence the development of advanced fibrosis. We investigated the association of commonly used medications and advanced fibrosis in non-alcoholic fatty liver disease patients with diabetes. Methods: Clinical information including demographics, medical history, medication history, biochemical and histologic variables were ascertained in 459 patients with biopsy proven non-alcoholic fatty liver disease. We compared characteristics of patients with and without diabetes and explored potential associations between classes of drugs as risk factors and advanced fibrosis among the diabetic patients with NAFLD. Results: Presence of diabetes was an independent risk factor for advanced fibrosis. In diabetic patients, age (OR 1.09; 95%CI 1.04-1.15, p=0.000) and grade of ballooning (OR 5.59; 95%CI 2.69-11.61, p=0.000) had a positive relationship with advanced fibrosis. The use of insulin (OR 4.95; 95%CI 1.65-14. Continue reading >>
Nonalcoholic Fatty Liver Disease In Patients With Type 2 Diabetes Mellitus And Its Association With Cardiovascular Disease - Sciencedirect
NONALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND ITS ASSOCIATION WITH CARDIOVASCULAR DISEASE Author links open overlay panel SivabalVanjiappana AbdoulHamidea RameshAnanthakrishnanb Senthilkumar GandhipuramPeriyasamyc VadivelanMehalingama Non-alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of liver disease that ranges from hepatic steatosis to non-alcoholic steatohepatitis. Obesity and diabetes mellitus are the prime risk factors for NAFLD. The aim of this study was to find out the prevalence of NAFLD among patients with type 2 diabetes mellitus and to detect the association of NAFLD with cardiovascular disease in them. The study was conducted on 300 patients with type 2 diabetes mellitus attending the outpatient department of a tertiary care teaching hospital. All patients underwent hepatic ultrasonography to look for hepatic steatosis. Among the 300 patients, 124 were divided into NAFLD and non-NAFLD groups based on the ultrasound findings. These patients were subjected to electrocardiogram, 2D echocardiogram, carotid intima media thickness (CIMT) measurement and ankle brachial pressure index measurement along with measurement of markers of oxidative stress. Hepatic steatosis was present in 61% of diabetic patients in this study. Cardiovascular disease was not found to be significantly associated in diabetic patients with NAFLD. However, cardiovascular risk factors like CIMT, high sensitivity c-reactive protein (hs-CRP) and malondialdehyde (MDA) were elevated in these patients. hs-CRP and MDA levels were found to be significantly associated with the severity of NAFLD. There is a high prevalence of NAFLD in type 2 diabetic patients. No correlation was detected between the presence of NAFLD and cardiovascular disease in th Continue reading >>
Half Of Patients With Type 2 Diabetes Have Nonalcoholic Fatty Liver Disease
Half of Patients With Type 2 Diabetes Have Nonalcoholic Fatty Liver Disease Commentary by Paola Portillo-Sanchez, MD, and Discussion by Giovanni Targher, MD Nonalcoholic fatty liver disease (NAFLD) was found in 50% of patients with type 2 diabetes who had normal aminotransferase levels in a recent study reported in the June issue of the Journal of Clinical Endocrinology & Metabolism. We found that in patients with type 2 diabetes mellitus, who were screened by the non-invasive gold-standard of liver magnetic resonance spectroscopy (1H-MRS), there was a surprisingly high prevalence of NAFLD (36% and 56% in overweight and obese, respectively), even in the absence of plasma AST/ALT elevations, said lead author Paola Portillo-Sanchez, MD, Post Doctoral Associate, Division of Endocrinology, Diabetes, and Metabolism at the University of Florida. Moreover, more than half of these patients (56%) had developed the more severe form of liver disease called nonalcoholic steatohepatitis (NASH), Dr. Portillo-Sanchez said. From these findings, the most important clinical implication for practitioners is that NAFLD and NASH occur frequently in patients with T2DM, regardless of aminotransferase levels, and therefore, AST and ALT should be interpreted with caution when screening or following these patients, Dr. Portillo-Sanchez said. The study involved 103 patients with type 2 diabetes and normal plasma aminotransferase levels, and without a prior diagnosis of NAFLD. The majority of patients (70%) were obese (BMI 30 kg/m2). The prevalence of NAFLD was 56% in patients with obesity and 36% in patients without obesity. Increasing body mass index was significantly associated with a greater prevalence of NAFLD (P=0.001). In addition, a higher plasma hemoglobin A1C was significantly associate Continue reading >>
Nonalcoholic Fatty Liver Disease, Diabetes Mellitus And Cardiovascular Disease: Newer Data
Nonalcoholic Fatty Liver Disease, Diabetes Mellitus and Cardiovascular Disease: Newer Data 2nd Medical Department and Diabetes Center, NIMTS Hospital, 12 Monis Petraki, 11521 Athens, Greece Received 9 March 2013; Accepted 12 March 2013 Copyright 2013 A. N. Mavrogiannaki and I. N. Migdalis. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Nonalcoholic fatty liver disease (NAFLD) is the most common, chronic liver disease worldwide. Within this spectrum, steatosis alone is apparently benign, while nonalcoholic steatohepatitis may progress to cirrhosis and hepatocellular carcinoma. NAFLD is strongly associated with obesity, dyslipidemia, type 2 diabetes mellitus, and cardiovascular disease. The pathogenesis of hepatic steatosis is not clearly known, but its main characteristics are considered insulin resistance, mitochondrial dysfunction, increased free fatty acids reflux from adipose tissue to the liver, hepatocyte lipotoxicity, stimulation of chronic necroinflammation, and fibrogenic response. With recent advances in technology, advanced imaging techniques provide important information for diagnosis. There is a significant research effort in developing noninvasive monitoring of disease progression to fibrosis and response to therapy with potential novel biomarkers, in order to facilitate diagnosis for the detection of advanced cirrhosis and to minimize the need of liver biopsy. The identification of NAFLD should be sought as part of the routine assessment of type 2 diabetics, as sought the microvascular complications and cardiovascular disease, because it is essential for the early diagnosis and proper inte Continue reading >>
International Textbook Of Diabetes Mellitus, 4th Ed., Excerpt #105: Treatment Of Nonalcoholic Fatty Liver Disease And Nonalcoholic Steatohepatitis Part 3
Home / Resources / Clinical Gems / International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #105: Treatment of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis Part 3 International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #105: Treatment of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis Part 3 Combined dietary intervention and exercise The available information on the role of combined lifestyle interventions (hypocaloric diets plus exercise) in patients with NAFLD is much more extensive, with several randomized, controlled trials showing significant benefit with this comprehensive approach [28,32,33,38,5658]. Again, the overall reduction in liver fat reported in most of these trials has been strongly correlated with the amount of weight loss. Table 20.4 summarizes the studies that have examined the effect of lifestyle intervention on liver fat by MRS. As expected, those studies that achieved a lesser degree of weight loss [28,31] had a smaller reduction in liver fat content. Of note, studies that have compared hypocaloric diet versus hypocaloric diet plus exercise have failed to report a significant difference in the improvement of liver fat content with the combined strategy, but in both studies weight loss was about the same with both interventions [28,56]. Keating et al. [48] reached a similar conclusion in a meta-analysis of all available studies, in which exercise plus diet had no significant pooled effect size (ES) when compared to diet alone (ES: 0.05; 95% CI 0.380.27, p=0.76). An unresolved issue about many of these trials is whether small absolute changes in liver fat (even if of statistical significance) truly have clinical relevance. For instance, Lazo et al. [32] and Larson-Meyer et al. [57] reported apparentl Continue reading >>
Type 2 Diabetes And Fatty Liver Disease
Non-alcoholic fatty liver disease is a group of conditions in which fat builds up in the liver, leading to inflammation of the cells where it is stored and causing the liver to get bigger. It can progress to more serious conditions, including fibrosis and cirrhosis of the liver. Fatty liver disease "is so common. It’s present arguably in a majority of type 2 diabetics,” says Daniel Einhorn, MD, clinical professor of medicine at the University of California, San Diego and the medical director of the Scripps Whittier Diabetes Institute. “None of us thought about it more than about 10 years ago, then all of a sudden we discovered it and see it all the time.” Fatty Liver Disease and Type 2 Diabetes: The Connection Diabetes does not cause fatty liver disease. Instead, the two diseases tend to occur in the same people because the same conditions cause both problems. “So, it’s not the diabetes per se. People with diabetes also have obesity and insulin resistance, and so the fatty liver is thought to be part of that,” Dr. Einhorn explains. Einhorn says that most cases of fatty liver disease do not cause any harm. However, since type 2 diabetes and obesity are so common in the United States, fatty liver disease is now a leading cause of end-stage (fatal) liver disease requiring a liver transplant, along with alcohol abuse and hepatitis. Fatty Liver Disease Diagnosis Fatty liver disease has no symptoms. People who are being treated for diabetes will have liver enzyme tests as part of their routine blood work during medical exams. Ninety-nine percent of the cases of fatty liver disease are detected by this test, says Einhorn. In some cases it will be picked up during the physical exam or in imaging studies, like a computed tomography scan of the abdomen or a liver ul Continue reading >>
Diabetes Mellitus And Non-alcoholic Fatty Liver Disease: The Thread Of Ariadne.
1. Minerva Endocrinol. 2017 Jun;42(2):109-121. doi: 10.23736/S0391-1977.16.02562-1. Epub 2016 Dec 16. Diabetes mellitus and non-alcoholic fatty liver disease: the thread of Ariadne. (1)Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece - [email protected] (2)Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece. Non alcoholic fatty liver disease (NAFLD, the hepatic fat accumulation) and nonalcoholic steatohepatitis (NASH, the aggressive form of liver steatosis plusinflammation and hepatocyte necrosis) are reaching epidemic dimensions insubjects with diabetes mellitus (DM). Taking into account that the incidence ofDM increases worldwide, these entities represent major health problems. There is accumulating evidence that diabetic subjects with NASH are at increased risk not only for cardiovascular disease compications but also for cirrhosis andhepatocellular cancer. On the other hand, the presence of NAFLD correlates withan increased risk for the development of DM. The most-widely acceptedpathophysiological mechanisms relating DM and NAFLD include central obesity andinsulin resistanc, but new insights are under scrutiny. Therapeutic modalitiesused for the management of diabetes have been studied for their impact onNAFLD/NASH and both neutral and beneficial effects have been reported. In thisreview, we discuss issues regarding the epidemiology, the pathophysiologicalpathways relating NAFLD with DM and consider strategies that may be useful in themanagement of NAFLD in the diabetic population. Continue reading >>
Nonalcoholic Fatty Liver Disease And Chronic Vascular Complications Of Diabetes Mellitus
Nonalcoholic fatty liver disease and chronic vascular complications of diabetes mellitus Nature Reviews Endocrinology volume 14, pages 99114 (2018) Nonalcoholic fatty liver disease (NAFLD) and diabetes mellitus are common diseases that often coexist and might act synergistically to increase the risk of hepatic and extra-hepatic clinical outcomes. NAFLD affects up to 7080% of patients with type 2 diabetes mellitus and up to 3040% of adults with type 1 diabetes mellitus. The coexistence of NAFLD and diabetes mellitus increases the risk of developing not only the more severe forms of NAFLD but also chronic vascular complications of diabetes mellitus. Indeed, substantial evidence links NAFLD with an increased risk of developing cardiovascular disease and other cardiac and arrhythmic complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus. NAFLD is also associated with an increased risk of developing microvascular diabetic complications, especially chronic kidney disease. This Review focuses on the strong association between NAFLD and the risk of chronic vascular complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus, thereby promoting an increased awareness of the extra-hepatic implications of this increasingly prevalent and burdensome liver disease. We also discuss the putative underlying mechanisms by which NAFLD contributes to vascular diseases, as well as the emerging role of changes in the gut microbiota (dysbiosis) in the pathogenesis of NAFLD and associated vascular diseases. Subscribe to Nature Reviews Endocrinology for full access: European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD) & European Association for the Study of Obesity (EASO). EASL-EASD-EAS Continue reading >>
Nonalcoholic Fatty Liver Disease In Type 2 Diabetes Mellitus
Nonalcoholic fatty liver disease in type 2 diabetes mellitus Purpose of reviewTo increase awareness about the close interrelationship between nonalcoholic fatty liver disease and type 2 diabetes mellitus, and of recent diagnostic and treatment advances in the field. Recent findingsThe perception of nonalcoholic fatty liver disease as an uncommon and benign condition is rapidly changing. Approximately 70% of persons with type 2 diabetes mellitus have a fatty liver and the disease follows a more aggressive course with necroinflammation and fibrosis (i.e. nonalcoholic steatohepatitis) in diabetes. New evidence suggests that it is not steatosis per se but the development of lipotoxicity-induced mitochondrial dysfunction and activation of inflammatory pathways that leads to progressive liver damage. Nonalcoholic steatohepatitis is a leading cause of end-stage liver disease and contributes to cardiovascular disease in patients with type 2 diabetes mellitus. Because nonalcoholic steatohepatitis may develop even in the presence of normal liver transaminases, a liver biopsy is still necessary for a definitive diagnosis. However, new imaging methods and plasma biomarkers are emerging as alternative diagnostic tools. Lifestyle intervention is the gold standard for the management of nonalcoholic steatohepatitis. Recent randomized controlled trials suggest thiazolidiendiones are promising therapeutic agents. SummaryNonalcoholic steatohepatitis is a frequently overlooked and potentially severe complication of type 2 diabetes mellitus. Patients may benefit from its early diagnosis and treatment. Diabetes Division, Department of Medicine, The University of Texas Health Science Center at San Antonio and the Audie L. Murphy Veterans Administration Medical Center, Texas, USA Corresponden Continue reading >>
Diabetes And Nonalcoholic Fatty Liver Disease: A Pathogenic Duo
Limitation of Use: The safety and efficacy of Humulin R U-500 used in combination with other insulins has not been determined. The safety and efficacy of Humulin R U-500 delivered by continuous subcutaneous infusion has not been determined. For the Humulin R U-500 vial, particular attention should be paid to the 20-mL vial size, prominent “U-500” and warning statements on the vial label, and distinctive coloring on the vial and carton. Dosing errors have occurred when Humulin R U-500 was administered with syringes other than a U-500 insulin syringe. Patients should be prescribed U-500 syringes for use with Humulin R U-500 vials. The dose of Humulin R U-500 should always be expressed in units of insulin. DO NOT transfer Humulin R U-500 from the Humulin R U-500 KwikPen into any syringe for administration. Overdose and severe hypoglycemia can occur. Hyperglycemia or Hypoglycemia with Changes in Insulin Regimen: Changes in insulin, manufacturer, type, or method of administration should be made cautiously and only under medical supervision and the frequency of blood glucose monitoring should be increased. Hypoglycemia: Hypoglycemia is the most common adverse reaction associated with insulin, including Humulin R U-500. Severe hypoglycemia can cause seizures, may be life-threatening, or cause death. Severe hypoglycemia may develop as long as 18 to 24 hours after an injection of Humulin R U-500. Hypoglycemia can impair concentration ability and reaction time; this may place an individual and others at risk in situations where these abilities are important, such as driving or operating other machinery. Early warning symptoms of hypoglycemia may be less pronounced in patients with longstanding diabetes, in patients with diabetic nerve disease, in patients using medications th Continue reading >>
Nonalcoholic Fatty Liver Disease And Chronic Vascular Complications Of Diabetes Mellitus
Nonalcoholic fatty liver disease and chronic vascular complications of diabetes mellitus Nature Reviews Endocrinology volume 14, pages 99114 (2018) Nonalcoholic fatty liver disease (NAFLD) and diabetes mellitus are common diseases that often coexist and might act synergistically to increase the risk of hepatic and extra-hepatic clinical outcomes. NAFLD affects up to 7080% of patients with type 2 diabetes mellitus and up to 3040% of adults with type 1 diabetes mellitus. The coexistence of NAFLD and diabetes mellitus increases the risk of developing not only the more severe forms of NAFLD but also chronic vascular complications of diabetes mellitus. Indeed, substantial evidence links NAFLD with an increased risk of developing cardiovascular disease and other cardiac and arrhythmic complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus. NAFLD is also associated with an increased risk of developing microvascular diabetic complications, especially chronic kidney disease. This Review focuses on the strong association between NAFLD and the risk of chronic vascular complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus, thereby promoting an increased awareness of the extra-hepatic implications of this increasingly prevalent and burdensome liver disease. We also discuss the putative underlying mechanisms by which NAFLD contributes to vascular diseases, as well as the emerging role of changes in the gut microbiota (dysbiosis) in the pathogenesis of NAFLD and associated vascular diseases. Subscribe to Nature Reviews Endocrinology for full access: European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD) & European Association for the Study of Obesity (EASO). EASL-EASD-EAS Continue reading >>
Diabetes: How Do I Help Protect My Liver?
If I have diabetes, is there anything special I need to do to take care of my liver? Answers from M. Regina Castro, M.D. You're wise to wonder about steps to protect your liver. Diabetes raises your risk of nonalcoholic fatty liver disease, a condition in which excess fat builds up in your liver even if you drink little or no alcohol. This condition occurs in at least half of those with type 2 diabetes. It isn't clear whether the condition appears more often in people with type 1 diabetes than in the general population because obesity, which is a risk factor, occurs with similar frequency in both groups. Other medical conditions, such as high cholesterol and high blood pressure, also raise your risk of nonalcoholic fatty liver disease. Fatty liver disease itself usually causes no symptoms. But it raises your risk of developing liver inflammation or scarring (cirrhosis). It's also linked to an increased risk of liver cancer, heart disease and kidney disease. Fatty liver disease may even play a role in the development of type 2 diabetes. Once you have both conditions, poorly managed type 2 diabetes can make fatty liver disease worse. Your best defense against fatty liver disease includes these strategies: Work with your health care team to achieve good control of your blood sugar. Lose weight if you need to, and try to maintain a healthy weight. Take steps to reduce high blood pressure. Keep your low-density lipoprotein (LDL, or "bad") cholesterol and triglycerides — a type of blood fat — within recommended limits. Don't drink too much alcohol. If you have diabetes, your doctor may recommend an ultrasound examination of your liver when you're first diagnosed and regular follow-up blood tests to monitor your liver function. Continue reading >>
