Obesity and Liver Disease - A Pan Kerala Scenario

KOCHI: The changing environment and lifestyle have had a tremendous impact on today's world. The World Health Organisation (2010) reports that as the world's population ages, gets richer, smokes more, eats more and drives more, liver diseases will continue to become bigger killers over the next 20 years.

With Keralites becoming more western, lifestyle diseases affecting them have also become more widespread. These diseases are different from others as they are potentially preventable and can be lowered with a change in diet, lifestyle, environment etc.  Drastic changes in our diet; food intake and energy expenditure increased the level of metabolic diseases such as diabetes and obesity leading to chronic liver diseases.

Lifestyle diseases are the outcome of an inappropriate relationship of people with their environment. In the second half of the 20th century, peoples diet changed substantially with increased consumption of meat, dairy products, vegetable oils, alcoholic and non-alcoholic beverages and with the decreased consumption of starchy staple foods. These changes along with lifestyle changes such as large reduction of physical activities and smoking have resulted in high prevalence of chronic liver diseases. The combination of four healthy lifestyle factors, mainly maintaining a healthy weight, regular exercise, healthy diet and non-smoking seem to be associated with reduction of 80 per cent reduction in the risk of deadly liver diseases.

Obesity and lifestyle diseases in children

Doctors agree in unison that obesity among children is rapidly rising in Kerala and according to estimates in the last National Health Survey report, Kerala stands second in the country after Punjab in child obesity.  According to another study by the state health department, in 1,500 schools across the state, one in two students face lifestyle diseases. The reasons cited include the change in lifestyle, eating pattern, activity pattern and the kind of food being taken. Experts say its high time planners and parents addressed the issue before it gets worse.  Report of the Indian Council for Medical Science and Technology (2010) revealed that the percentage of diabetes, hypertension, overweight and cholesterol among the population of Kerala are 16.2 per cent, 32.7 per cent, 30.8 per cent and 56.8 per cent respectively.  After alcohol, these nasty four are the main reason for liver diseases in kerala.

The increased consumption of high calorie foods and lack of physical activity among Keralites has taken its toll on public health, especially among the women and children in the form of obesity, diabetes mellitus, metabolic syndrome and liver diseases.  Most of the modern fast food items contain dangerous trans fats. By including fast food and junk food in the diet, Keralites are inviting liver diseases. One of the important causes of positive energy balance among children and young adults is fast food consumption. Another frequently used source of energy is soft drinks. As with fast food, studies generally establish that drinking these beverages results in higher overall energy intake. Buying a 600 ml bottle of cola on the way from school has become routine for children. Research has proved that a glass of fizzy soft drink is nothing less than a killer assault on the body. There is a positive link between overweight and soft drink consumption. Another much studied source of energy intake is snacks. Snack foods are often densely caloric, prepared, processed and packaged foods. A significant and positive relationship between Energy Dense Snack (EDS) food consumption and television viewing is found to exist among young adults.

Hallmarks of NAFLD

A bright liver at ultrasound and increased levels of hepatic enzymes are the hallmarks of the whole spectrum of Non-alcoholic fatty liver disease (NAFLD). They are common in obesity and their prevalence increases progressively with increasing BMI. Liver fat varies with the degree of obesity, and in longitudinal studies even small changes in body weight (on average 1.3-2.5 kg) are associated with the ultrasonographic appearance/disappearance of steatosis. A comprehensive review of the literature indicates that the presence of obesity increases the risk of elevated liver enzymes by a factor of two or three, whereas the risk of steatosis at ultrasonography is increased by a factor of three in the presence of overweight. The importance of liver disease in obesity is not limited to initial NAFLD stages. Both cirrhosis and HCC are associated with obesity. 

In both men and women high BMI was also significantly associated with higher rates of liver cancer-related death. Diabetes and obesity are also associated with poor survival in NAFLD. Detrimental effect of obesity probably occurs in subjects with HCV infection, familial hemochromatosis or in subjects with alcohol-induced liver disease, where the presence of obesity further increases the risk of steatosis.

 — Dr Charles Panackel,  Live Care -Aster Medcity