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To study the prevalence of non-alcoholic fatty liver disease (NAFLD) in patients presenting for routine health checkup and To establish the relationship between NAFLD and various component of metabolic synbrome.PATIENTS AND METHODS: 500patients attending the medical OPD for health checkup had their blood pressure, height and weight, waist and hip circumference measurements, waist-hip ratio, blood sugars, lipid levels and ultrasound abdomen done after applying exclusion criterias.Those with normal ultrasound abdomen weretaken as control and those with NAFLD were taken as cases. The prevalence of NAFLD among these subjects was determined and the presence of risk factors for metabolic disease in each individual was analysed. A relationship between NAFLD and metabolic syndrome was then established.RESULTS: Of the 500people 198 (39.6%) had NAFLD.The prevalence is higher among females 127/282 (45%) than males 71/218 (32.6%).In the NAFLD group normal body mass index (BMI) was present in only 50/198 (25.3%) of the subjects while 89/198 (44.95%) were overweight and 59/198 (29.8%) were obese. Whereas in control group normal BMI was present in 199/302 (65.9%), overweight were 86/302 (28.5%) and only 17/198 (5.6%) were obese.Prevalence of metabolic syndrome was 137/198 (69.2%) among cases and 95/302 (31.5%) among controls.CONCLUSION: A diagnosis of fatty liver on ultrasound in an asymptomatic person should alert us of metabolic syndrome and its progression to cardiovascular disease. NAFLD may be considered as the hepatic component of metabolic syndrome. KEY WORDS:Non-alcoholic fatty liver disease (NAFLD), Metabolic syndrome, Diabetes mellitus. INTRODUCTION: The term "non-alcoholic fatty liver" was first used in 1980, to describe a clinico pathologic syndrome that occurred in obese, diabetic females who denied alcohol use, but in whom the hepatic histology was consistent with alcoholic hepatitis 1. It is a spectrum of liver diseases ranging from hepatosteatosis (fatty liver), to non-alcoholic steatohepatitis (NASH) (fat with inflammation), through to fibrosis and potentially cirrhosis and hepatocellular carcinoma without a history of immoderate alcohol use. 2-4 The maximum allowable level of alcohol intake for definition of NAFLD is 2 standard drinks a day (140 g ethanol/week) for men, and one standard drink a day (70 g ethanol/week) for women. 5 The prevalence of NAFLD is 15 to 40% in western countries and 9-40% in Asian countries. 5 Though there are many invasive and non-invasive methods of detecting NAFLD, the most frequent and readily available method to measure hepatic steatosis is by ultrasonography, by which patients with more than 30% liver fat can be diagnosed accurately. 6 Haller and colleagues used the term "metabolic syndrome." Studies in Asia, suggest its prevalence of 5-20%, with an overall global prevalence of around 16% of the adult population. 7,8

INTRODUCTION: Pulmonary abnormalities and symptoms are common in patients with chronic liver disease. Hepatopulmonary syndrome is an important cause in a patient with hypoxemia and chronic liver disease. Hepatopulmonary syndrome consists of a triad of hepatic dysfunction and/or portal hypertension, intrapulmonary vascular dilatations and hypoxemia/ widened alveolararterial gradient. The present study evaluated the arterial blood gas levels and correlated these with 2D contrast echocardiographic findings in patients of liver cirrhosis. METHODS: 40 patients of liver cirrhosis were included in the study. All patients underwent ultrasonography, LFTs, biochemical tests and upper gastrointestinal endoscopy, chest X-ray, 2-D contrast enhanced transthoracic echocardiogram, viral markers and arterial blood gas analysis. The patients in whom arterial hypoxemia/ widened alveolar-arterial gradient was detected with a positive contrast echocardiogram were considered to have hepatopulmonary syndrome. Patients with intrinsic heart disease like patent foramen ovale, atrial septal defect, ventricular septal defect, haemoglobin less than 7gm% and history of COPD were excluded from the study. RESULTS: 4 patients of liver cirrhosis with hypoxemia had intrapulmonary vascular dilatations were labelled as hepatopulmonary syndrome. 2 additional patients with IPVDs had widened alveolar arterial gradient without hypoxemia and were also labelled as HPS. Dyspnoea (p=0.001), platypnea (p<0.001), clubbing (p=0.002) and cyanosis (p=0.001) were significantly commoner in the six patients of hepatopulmonary syndrome. Patients with cyanosis had poor prognosis. CONCLUSION: Hepatopulmonary syndrome is an important cause of hypoxemia in patients of liver cirrhosis. It is not uncommon in patients of liver cirrhosis. Platypnea is both sensitive as well as specific marker of the disease. Transthoracic contrast enhanced echocardiogram is a safe and accurate bedside tool for the detection of IPVDs.