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From the Townsend Letter
April 2014

Nonalcoholic Fatty Liver Disease
in Chronic Hepatitis C

by Lyn Patrick, ND
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Page 1, 2

Notes
1.  Williams CD, Stengel J, Asike MI, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140:124–131.
2.  Bialek SR, Terrault NA. The changing epidemiology and natural history of hepatitis C virus infection. Clin Liver Dis. 2006;10:697–715.
3.  Colvin HM, Mitchell AE, eds. Hepatitis and Liver Cancer: a National Strategy for Prevention and Control of Hepatitis B and C. Washington, D.C.: National Academies Press; 2009:237.
4.  Patel A, Harrison S. Hepatitis C virus infection and nonalcoholic steatohepatitis. Gastroenterol Hepatol. 2012;8(5):305–312.
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6.  Ohata K, Hamasaki K, Toriyama K, et al. Hepatic steatosis is a risk factor for hepatocellular carcinoma in patients with chronic hepatitis C virus infection. Cancer. 2003;97:3036–3043.
7.  Poynard T, Ratziu V, McHutchison J, et al. Effect of treatment with peginterferon or interferon alfa-2b and ribavarin on steatosis in patients infected with hepatitis C. Hepatology. 2003;38:75–85.
8.  Shaheen M, Echeverry D, Oblad MG, et al. Hepatitis C, metabolic syndrome, and inflammatory markers: results from the third national health and nutrition examination survey [NHANES III]. Diabetes Res Clin Pract. 2007;75:320–326.
9.  Chalasani N, Younossi Z, Lavine J, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guidelines by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. Epub 2012. http://www.aasld.org/practiceguidelines/Documents/NonalcoholicFattyLiverDisease2012_25762_ftp.pdf 110.
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20.  Finelli C, Tarantino G. Is there any consensus as to what diet or lifestyle approach Is the right one for NAFLD patients? J Gastrointestin Liver Dis. September 2012;21(3):293–302
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23. Tishinsky JM, Dyck DJ, Robinson LE. Lifestyle factors increasing adiponectin synthesis and secretion. Vitam Horm. 2012;90:1–30.
24.  Kim S, Kwon H, Park JH, et al. A low level of serum testosterone is independently associated with nonalcoholic fatty liver disease. BMC Gastroenterology. 2012;12:69.
25.  Kraus MR, Schafer A, Bentink T, et al. Sexual dysfunction in males with chronic hepatitis C and antiviral therapy: interferon-induced functional androgen deficiency or depression? J Endocrinol. 2005;185;345–352.
26.  Nguyen HV, Mollison LC, Taylor T, et al. Chronic hepatitis C infection and sex hormone levels: effect of disease severity and recombinant interferon-α therapy. Int Med J. 2006;36:362–366.
27.  Jain SK, Pemberton PW, Smith A, et al. Oxidative stress in chronic hepatitis C: not just a feature of late stage disease. J Hepatol. 2002;36(6):805–811.
28.  Choi J , Ou JH. Mechanisms of liver injury III. Oxidative stress in the pathogenesis of hepatitis C virus. Am J Physiol Gastrointest Liver Physiol 2006;290:847–851.
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30.  Lai IK, Dhakal K, Gadupudi GS, Li M, et al. N-acetylcysteine (NAC) diminishes the severity of PCB 126-induced fatty liver in male rodents. Toxicology. 2012 Dec 8;302(1):25–33.
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33.  Himoto T, Hosomi N, Nakai S, et al. Effect of zinc administration in patients with hepatitis C virus-related chronic liver disease. Scand J Gastroenterol. 2007;42:1078–1087.
34.  Arteh J, Narra S, Nair S. Prevalence of vitamin D deficiency in chronic liver disease. Dig Dis Sci. 2010;55:2624–2628.
35.  Milazzo L, Mazzali C, Bestetti G, et al. Liver-related factors associated with low vitamin D levels in HIV and HIV/HCV coinfected patients and comparison to general population. Curr HIV Res. 2011;9:186–193.
36.  Sardar S, Chakraborty A, Chatterjee M. Comparative effectiveness of vitamin D3 and dietary vitamin E on peroxidation of lipids and enzymes of the hepatic antioxidant system in Sprague-Dawley rats. Int J Vitam Nutr Res. 1996;66:39–45.
37.  Bitetto D, Fabris C, Fornasiere E, et al. Vitamin D supplementation improves response to antiviral treatment for recurrent hepatitis C. Tranpl Int. 2011;24:43–50.

Lyn Patrick, NDLyn Patrick, ND, graduated from Bastyr University in 1985 and has practiced in Arizona and Colorado for the last 27 years as a primary care provider specializing in environmental medicine and chronic hepatitis C. Her expertise in chronic hepatitis C originated with her work in an HIV practice and matured in her collaboration with the Hepatitis C Ambassadors as part of the Hepatitis C Brainstorming Team (http://www.hepcchallenge.org/brainstorming.htm). This international team of doctors, epidemiologists, acupuncturists, NDs, and advocates has worked together to provide an integrative health model for the treatment of chronic hepatitis C. The group has written a free online book for patients that spans the spectrum of diagnosis and care (http://www.hepcchallenge.org/choices/index.htm). Dr. Patrick also lectures internationally on fatty liver disease and chronic hepatitis C to health-care providers and is currently coteaching a Hepatitis C Certification Program with Misha Cohen, OMD, through Progressive Medical Education (www.progressivemedicaleducation.com).

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