KOCHI: The liver performs almost all vital functions in our body, including cleansing it from toxins and chemicals, regulating the supply of energy, vitamins and fatty acids. It works around the clock. But we get to know something is wrong only when much damage has happened.
Patients with chronic liver disease are already under immune deregulation, which makes them vulnerable to severe infections. People with chronic liver diseases show delayed recovery from infections, including Covid, according to various studies.
Liver disease is the 10th most common cause of death in India. It leads to more than one lakh deaths. Over 10 lakh new cases of chronic liver diseases are identified annually, according to WHO data. Alcoholic liver disease is the major cause of liver damage, followed by Hepatitis B and C infections and non-alcoholic liver disease.
Liver diseases including cirrhosis have become a new pandemic in Kerala, causing more than 8,000 deaths every year. Fatty liver, often caused by alcohol consumption, can be observed after a few days of heavy drinking. According to a study, consuming 75-100 ml/day of alcohol by men or 25ml/ day by women over 20 years can cause steatohepatitis and fibrosis. Hepatitis B and C infections are also prevalent in less than 0.75 % of the state’s population, which is much less than the national average.
Worldwide, over 25 per cent of the population is affected by obesity. Lifestyle diseases like diabetes and hypertension and non-alcoholic fatty liver disease (NAFLD) have also become increasingly common. In many countries, NAFLD is the leading cause of liver damage now. This trend is also being witnessed in Kerala.
A good percentage of Malayalis are at the early stage of this disease, commonly called the fatty liver (close to 35% is the national average). No definite symptoms or functional alterations are observed at this stage, but if left unattended, it can progress to non-alcoholic steatohepatitis (NASH) where the liver cells start to get inflamed and damaged. Eventually, if left unattended, it can lead to scarring and fibrosis, reaching Cirrhosis at a later stage.
This whole transition happens over 20+ years in most cases. In a few, it develops earlier too. A sedentary lifestyle, fat-rich foods, and fructose-rich drinks with a lack of proper physical activity are the root causes. Alcohol consumption in individuals with vulnerability to NAFLD would further accelerate the progression to end-stage liver disease.
Routine liver function tests like SGPT, SGOT, PT-INR, GGT Albumin or globulin ratio can bring out slightly deranged results in earlier phases. But it does not completely correlate with the disease stage. Any elevations in these tests would warrant a clinical correlation. Liver biopsy is the gold standard test for accurately assessing the stage of liver disease, but is seldom performed due to difficulty in the procedure and risks of complications.
The author is a consultant pathologist and Head of Pathology at Sudharma Metropolis Thrissur