On the occasion of International NASH (Non-Alcoholic Steatohepatitis) Day, the Indian National Association for Study of the Liver (INASL) launched an ‘Action Plan for the Prevention and Control of Non-Alcoholic Fatty Liver Disease (NAFLD) in India’. NAFLD is a disease that affects 25-30 per cent of the world’s population; in India, its prevalence is close to 40 per cent. “In our liver clinic at PGI, which has OPDs twice a week, we see as many as 30 to 40 patients with fatty liver a week and the incidence is rising not only in the urban but rural population of the Chandigarh,” said Prof Ajay Duseja, who is the department head of the department of Hepatology. NAFLD is a spectrum that ranges from simple fat in the liver called simple steatosis or Non-Alcoholic Fatty Liver (NAFL) to NASH which is associated with inflammation (swelling) and scarring (fibrosis). Patients with NASH are at a higher risk of progressing to cirrhosis liver (scarred liver) and liver cancer. In fact, NAFLD has now become the most common chronic liver disease in Asia and India. It is also the most common cause of cirrhosis and liver cancer in patients who do not consume alcohol and do not have hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. The main reasons for NAFLD in India are the metabolic risk factors related to a sedentary lifestyle and intake of high-calorie food. Overweight or obesity, diabetes mellitus (blood sugar), hypertension (high blood pressure) and dyslipidemia (deranged blood lipids) are the main risk factors for NAFLD, even though some patients may be predisposed genetically. The diagnosis of NAFLD is usually simple based on blood tests, ultrasound, and a few other tests but may be delayed due to a lack of symptoms in the early stage. The disease may also be ignored by the patients and physicians alike due to slow progression and lack of specific complaints, said PN Rao, Chief of Hepatology at Asian Institute of Gastroenterology, Hyderabad. In addition to affecting the liver, NAFLD has also become a very common risk factor for various extra-hepatic diseases like cardiovascular diseases, chronic kidney disease, bone loss, obstructed sleep apnea, and cancers of various organs, added Prof. Yogesh Chawla, former director of PGI. The treatment of patients with NAFLD revolves around maintaining a good lifestyle with a good diet and regular exercise. “Those with overweight and obesity are encouraged to lose weight by cutting down on their calorie intake and by burning more calories by aerobic or anaerobic exercises. Patients who progress on to a severe form of the disease (NASH with or without fibrosis, cirrhosis, liver cancer) do require other modalities of treatment including pharmacological drugs, endoscopy, and liver transplantation for those with liver failure,” added Prof Subrat K. Acharya, former head, gastroenterology, AIIMS, Delhi. Twenty-four ICON-D experts from different parts of the country had a brainstorming session here in Chandigarh to chart out the plan for the prevention and control of NAFLD. It was unanimously decided that the action plan should focus on the education of the general public and health care providers. Since NAFLD has recently been included in one of the national programs of the country, it was decided to work closely with the administration and local health authorities to better implement this program.
