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 Dr Charles Panackel, Consultant in Hepatology and Liver Transplantation, Aster Medcity, Kochi What is fatty liver ?
Fatty liver is a life style disorder affecting millions of people.
It is a reversible condition wherein fat accumulate in liver cells leading to
enlargement of liver, inflammation and liver cell destruction. Two common causes
for fatty liver are alcohol intake and non-alcoholic fatty liver disease or
NAFLD. NAFLD is a disorder of fat metabolism wherein the fat can accumulate in
the liver in excessive amounts, thus resulting in a fatty liver.
NAFLD is a chronic yet silent disease, which means that most patients live with
it for several years without experiencing any symptoms and are mostly unaware of
their liver condition. NAFLD can progress to more serious disease stages, such
as advanced fibrosis, cirrhosis, liver failure or liver cancer.
What are the risk factors for NAFLD?
Nonalcoholic fatty liver or NAFLD is a life style disorder and is mainly seen in
persons with metabolic syndrome. Components of metabolic syndrome are obesity,
diabetes, hypertension, high cholesterol or triglycerides in blood. Persons with
various combinations of these four diseases are at risk of developing fatty
liver of NAFLD. With sedentary life style and changing diet pattern’s, obesity and diabetes have become an epidemic.
It is difficult to obtain an accurate estimate of NASH prevalence given the fact
that NASH is a silent disease, and a disease that remains difficult to diagnose
for the time being, But the trends are clear: non-alcoholic fatty liver disease
(NAFLD) is growing to become the most common chronic liver condition
in relation to the obesity and type 2 diabetes epidemics.
Various studies have shown that Kerala is the diabetes capital of India with a
prevalence of diabetes as high as 20% ─ double the national average of 8%.
Obesity is also on the rise among our children with 50% of children in urban
area’s being obese. Recent National health survey has shown that Kerala is
becoming the capitol of life style diseases. With rise in prevalence of obesity
and diabetes among the public its complications like NAFLD is also on the rise.
NAFLD is now one of the leading cause of liver cirrhosis, liver transplant and
liver transplantation.
How to diagnose NAFLD?
NASH is a silent disease. Consequently, NASH patients can remain unaware of
their liver condition until the disease progresses to more serious and
life-threatening stages. Thus, there is a major challenge related to NASH
diagnosis: the early identification of patients at risk of progressing to most
advanced stages of NASH.
The diagnosis of NAFLD is often made during an ultrasound examination of liver.
The ultrasound examination stages NAFLD as Grade one to three. The severity of
disease is accessed by help of liver function tests, fibroscan of liver and
liver biopsy. All persons with risk factors for NAFLD or symptoms suggestive of
NAFLD should have an ultrasound liver and liver function tests. If an ultrasound
shows fatty liver then a fibroscan of liver is the next step. Fibroscan helps to
measure the hardness or stiffness of the liver and is an indirect marker of
liver fibrosis. Persons with abnormal liver function test and fibroscan values
should have a liver biopsy to access the stage of disease and prognosis.
Why Diagnose NAFLD?
Non-alcoholic steatohepatitis patients have a higher risk of progression to
cirrhosis, end stage liver disease, liver transplant and hepatocellular
carcinoma. Therefore, it is critical to resolve NAFLD before it has a chance to
lead to cirrhosis or cancer, and associated life-threatening outcomes.
NAFLD patients with their obesity, diabetes, hypertension and high triglycerides
are at higher risk of cardiovascular events. Their atherosclerotic and
inflammation markers are higher than those of healthy individuals. In fact,
cardiovascular disease is the most common cause of death in NAFLD patients (38%
of cases), before non-liver cancer (19%) and liver-related complications (9%).
How to treat NAFLD?
Life style modifications are the main stay of treatment of NAFLD. Always
advocate for an active life style. Aim to take at least ten to fifteen thousand
steps a day. Avoid snacking in between meals and avoid empty calories like
cakes, sweets and ice cream. Avoid cola’s and high fructose containing drinks.
Weight reduction with diet and exercise should be began in all persons with
NAFLD. Exercise 30 minutes every day and can be aerobic or resistance exercise
depending on the personal preference. Exercise alone does not lead to weight
loss. A low fat, hypocaloric diet is a must. Reduction of daily calorie by
500-1000cal along with exercise helps to reduce weight. A Mediterranean diet
consisting of high intake of fruits and vegetables and low processed food helps
in resolving liver fat.
Medicines are advised only in persons with advanced liver disease on liver
biopsy and should be under the supervision of a trained doctor. Avoid taking
over the counter medicines and herbal preparations.
Risk factors like diabetes, cholesterol and hypertension should
be controlled well and helps in reducing heart disease and strokes.
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