Preventive strategies in chronic liver disease: Part I. Alcohol, vaccines,toxic medications and supplements, diet and exercise

Chronic liver disease is the 10th leading cause of death in the United Stat es. Hepatitis C virus infection is the most frequent cause of chronic liver disease and the most common indication for liver transplantation. Preventi ve care can significantly reduce the progression of liver disease. Alcohol and hepatitis C virus are synergistic in hastening the development of cirrh osis; therefore, patients with hepatitis C infection should abstain from al cohol use. Because superinfection with hepatitis A or B virus can lead to l iver failure, vaccination is recommended. Potentially hepatotoxic medicatio ns should be used with caution in patients with chronic liver disease. In g eneral, nonsteroidal anti-inflammatory drugs should be avoided; acetaminoph en in a dosage below 2 g per day is the safest choice. Many herbal remedies are potentially hepatotoxic, and only milk thistle can be used safely in p atients who have chronic liver disease. Weight reduction and exercise can i mprove liver function in patients with fatty liver.