Emerging liver health crisis in Kerala - an interplay of lifestyle and bad genetics

Two decades ago Kerala’s health status was almost at par with that of developed economies.

Published: 24th April 2018 10:40 PM  |   Last Updated: 25th April 2018 03:52 AM   |  A+A-

Express News Service

KOCHI: Two decades ago Kerala’s health status was almost at par with that of developed economies. The state has succeeded in increasing life expectancy as well as reducing health indices like infants and maternal mortalities.

Historically, public distribution of food, Kerala’s publicly funded healthcare system, high literacy rate, especially among the females, played a major role in improving the health scenario. The Kerala Model of Health used to be referred to as ‘good health based on social justice and equity’. Although Kerala has long been known for spectacular feats in the field of health and boasting of social development indicators comparable to developed countries, an alarming increase in lifestyle disorders is pushing the state into a health crisis.

Rising affluence, changes in lifestyle, junk food habits, obesity and rising incidence of diabetes have all contributed in varying degrees to the health crisis. Non-resident Keralites who played a pivotal role in economic development of the state indirectly contributed to the

lifestyle changes mentioned above. Sedentary lifestyles clubbed with high liquor consumption is a problem in the state resulted in metabolic imbalance, diabetes and ultimately various organ damage.

The brunt of attack due to this aberrant lifestyle is borne by liver. Although it may not receive the same amount of attention as organs such as the heart or brain, every bit of the unassuming liver is nonetheless crucial to life. On top of the over 500 vital functions including filtering, cleansing, manufacturing and digestive functions that it performs, the liver has the amazing ability to regenerate and return to its original size, even after the removal of up to 75 percent of the organ. Nonetheless, unhealthy lifestyles have pushed the livers of millions of people to the limit, leading to what experts are calling a silent epidemic of liver disease; a majority of this is contributed by fatty liver disease.

What is a fatty liver disease?

A staggering 25 percent of the global population has Non-Alcoholic Fatty Liver Disease (NAFLD), a condition where fat makes up more than five percent of the liver. Fatty liver can occur commonly with excessive consumption of alcohol. Those who don’t consume alcohol can develop the fatty liver disease in the background of a sedentary lifestyle, unhealthy food habits, a condition called Non Alcoholic fatty liver disease (NAFLD). Over the period—years or decades in some cases—NAFLD progresses to a more serious condition called ‘fatty swelling’ or non-alcoholic steatohepatitis (NASH), where the liver becomes inflamed and scarred, and liver structure and function are deranged.

Without treatment, the disease worsens to liver cirrhosis, a late-stage disease where a liver transplant is the only life-saving option for the patient. NAFLD is not entirely lifestyle mediated. Genetics also seems to play a role. Specific genes like PNPLA3 have been identified which predisposes individuals to diabetes and fatty liver disease. Unfortunately, this diabetes and fatty liver inducing ‘bad genetics’ are seen more commonly in Asian population than in the western world. Till now these bad genetics did not surface due to poverty and agrarian economy in Asia,which made physical exercise mandatory.

With Asian economies evolving in a big way sedentary lifestyle, over-eating and alcoholism contributed to unmasking the bad genetics inducing fatty liver disease. What seems to be an alcoholic liver disease, in fact, could be a combination of genetically linked

NAFLD and alcohol-induced liver damage- both alcoholic and non-alcoholic fatty liver disease with its attendant liver scarring, liver failure and liver cancer risk is the growing epidemic especially in Kerala where lifestyle changes were imbibed at a rapid rate as compared to rest of India.

In Kerala, it is not uncommon to find youngsters in their thirties with liver cirrhosis. Alcoholism which begins in campuses clubbed with genetically linked lifestyle liver disease namely NAFLD probably is the reason behind this alarming phenomenon.Creating awareness among the young generation, from school days onwards regarding how over nutrition, lack of exercise along with abuse of alcohol is the way to go to curb this liver health crisis.

Dr Harikumar Nair, Senior Consultant, Hepatology

Dr Abhishek Yadav, Senior Consultant, Liver Transplantation

VPS Lakeshore

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