Liver disease is regularly associated with excessive alcohol use, but Non-Alcoholic Fatty Liver Disease (NAFLD) is relatively less known. If left undiagnosed and untreated, it may lead to liver cirrhosis. Liver diseases are largely silent without causing any signs or symptoms in the patient.
The damage which happens to liver tissues through the stages of fatty liver, fatty hepatitis and liver scarring. This entire injury happens over a span of two decades or more. Most of the time in countries like India where screening programmes are not active, liver cirrhosis is detected at a stage when a patient needs a liver transplant to survive. This underlines the necessity to undergo screening to detect the disease and arrest its progression.
Once significant liver scarring or cirrhosis sets in, reversibility cannot be guaranteed. Nowadays, it is not uncommon to find people in their 30s developing liver cirrhosis. Alcoholism which begins in campuses (and even schools) clubbed with genetically linked NAFLD is probably the reason behind this alarming phenomenon.
We have to create awareness among students, while in school, about how nutrition, lack of exercise along with abuse of alcohol may lead to the deterioration of liver health. Sedentary lifestyle clubbed with high liquor consumption is a problem in urban settings, which results in metabolic imbalance, diabetes and ultimately various organ damage.
Non-alcoholic steatohepatitis (NASH) is the worst form of fatty liver. It is seen in 10 per cent of patients with fatty liver. It is a progressive condition characterised by inflammation of the liver leading to cell death. Long-standing inflammatory milieu leads to fibrosis (liver scarring) and eventually to cirrhosis.
NAFLD and metabolic syndrome
It is the most common cause of abnormal liver tests in the community and is closely associated with metabolic syndrome comprising central obesity, type 2 diabetes mellitus (DM), hypertension and hyperlipidemia. NAFLD may be present in at least 50-70 per cent of patients with type 2 DM. In patients with NAFLD, the prevalence of metabolic syndrome is around 40 per cent. It is emerging as an important health concern in adults and children because it increases risk of type 2 DM, hypertension, heart attacks and death. Studies are being conducted to identify genetic, ethnic and environmental risk factors for NAFLD and metabolic syndrome.
How does it happen?
NAFLD patients have been found to have a complex metabolic imbalance in fat cells in the belly (adipocytes) and liver. Increased intake of carbohydrate and fructose-containing diet results in high insulin levels which doesn’t reduce sugar.
Right now there are no drugs proven to reduce NASH. Current therapy is a multi-dimensional approach such as lifestyle modification, weight loss, change in dietary habit and exercise. Weight loss of 5 to 10 per cent over six months has been shown to improve NAFLD and obesity.
High-calorie intake and a diet rich in carbohydrates and saturated fats should be avoided. Most of the fast-foods contain transfat which has been shown to worsen liver injury and increase hepatic triglycerides. Many soft drinks contain fructose that increases lipogenesis, insulin resistance and NAFLD. Doctors recommend poly unsaturated fatty acid as they seem to improve liver enzymes.
Moderate exercise while spending at least 400 calories three to four times a week has shown to improve NAFLD.
(The writer is the senior consultant hepatologist and liver transplant physician, Gleneagles Global Health City, Chennai)