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Journalism of Courage
Fatty liver, put simply, is a build-up of fat in the liver. While any liver contains small amounts of fat, additional fat deposition amounting to more than five per cent of your liver’s weight can lead to fatty liver disease. What is worrisome is that in the absence of specific symptoms, many people with fatty liver don’t even know they have the condition.
The liver is the only organ in your body that can regenerate itself by replacing old, damaged cells with new ones. But this functionality is affected as the liver struggles to get rid of the fat. Once the scar tissue builds up, the liver finds it difficult to transport nutrients around the body and increase pressure in the surrounding veins. Over time, the excess fat damages your liver cells and causes inflammation. However, what’s most worrisome is that even when people are detected with a fatty liver, they tend to ignore it simply because they don’t feel its effects. “Also, just because fatty liver is common among Indians, they think it is a routine problem and not harmful – this is the biggest myth about fatty liver,” says Dr Arvinder Singh Soin, Chairman and Chief Surgeon, Medanta Institute of Liver Transplantation.
Why do we need to take a fatty liver diagnosis seriously?
About one-third of adults in India suffer from fatty liver disease. Which means three to four out of every 10 people have a fatty liver. It is a warning sign and indicates that these people could develop a serious liver disease in their lifetime. Untreated, fatty liver can increase your risk of more serious conditions, including cirrhosis (scarring of the liver) and even liver cancer. So, the condition should never be ignored.
Why should we worry about Non-Alcoholic Fatty Liver Disease (NAFLD) more?
First let’s understand the two types of fatty liver: alcoholic and non-alcoholic. Alcoholic fatty liver develops due to excess consumption of alcohol. So how do we quantify excess? It means consuming more than 10 units of alcohol a week for a man and more than eight units of alcohol a week for a woman over eight years. But Non-Alcoholic Fatty Liver Disease (NAFLD) happens because of four reasons — uncontrolled diabetes, dyslipidemia or excess bad cholesterol, obesity (when you are overweight by over 10 per cent of your body mass index [BMI]) and a sedentary lifestyle. Usually, the lifestyle benchmarks include lack of exercise, poor diet, overconsumption of fried or processed foods, sweets and red meat. All of these cause fatty liver, and in the long run, can even cause heart and neurovascular diseases. In fact, our diet and lifestyle are the biggest reasons that NAFLD is now a worldwide epidemic.
Now NAFLD damages the liver to such an extent that one-third of adult liver transplants in this country are because of liver failure or liver cancer caused by it. To be more precise, 35 per cent of patients who undergo a liver transplant have underlying NAFLD while 25 per cent of them have alcoholic fatty liver disease. So, 60 per cent of the patients who need liver transplant have fatty liver disease. The remaining 40 per cent of liver transplants are because of other causes like Hepatitis C, Hepatitis B, metabolic diseases, acute liver failure and so on.
How do I know that I have NAFLD?
The problem is that it doesn’t show any symptoms in the initial stages. So if someone has diabetes, obesity, dyslipidemia, a poor diet, drinks excess alcohol and does not exercise, then that individual is a sitting duck for fatty liver disease. Such a person should get the following liver tests done in a routine course and be regular with them — Liver Function Test (LFT), ultrasound of the abdomen and fibro scan. That’s because slowly over time, the liver will develop inflammation which is called steatohepatitis or NASH (Non-alcoholic steatohepatitis) and the patient will start experiencing pain in the right side of the upper abdomen, reduced appetite and fatigue. When the disease advances, then the individual experiences scarring, fibrosis, cirrhosis, yellowness in the eyes, jaundice, water accumulation in the body, be it in the stomach or legs, blood in the vomit or stool, confusion and drowsiness (this means the liver disease is affecting the brain). About 25 per cent of liver disease cases can develop liver cancer.
Can NAFLD be reversed? How long can this process take?
If fatty liver is diagnosed in the early stages, then the symptoms can be controlled and reversed to an extent but not completely. But if it is diagnosed late, when the liver has already become inflamed or is in the late stage of liver failure, then the individual has to eventually get a liver transplant.
What preventive measures should be taken to reverse NAFLD in the early stages and is it possible for individuals to fully regain their previous level of activity?
A fatty liver can be reversed if it is caught in the earlier stages, when there is only fat, but no inflammation or fibrosis. Then one can control diabetes, take cholesterol lowering drugs (if one has bad cholesterol), lose weight, maintain a proper diet which means not eating processed foods, using olive oil, eating a lot of fruits and vegetables, whole fibre, pulses, nuts, fish. One should also do cardio exercises — ideally for about 180-240 minutes a week and stop consuming alcohol to reverse fatty liver. There are certain medicines which can also help control fatty liver.
How many NAFLD patients are at risk of cirrhosis?
About 10 to 15 per cent of fatty liver patients who leave it unattended will develop cirrhosis. About 10-15 per cent of NAFLD patients who do not control causative factors will eventually develop serious liver disease. Cirrhosis means a lot of scarring in the liver. This happens because of persistent damage (excessive fat and inflammation) to the liver over many years.
Has there been any recent breakthrough research or development in the treatment of fatty liver disease?
Yes, medications have come through but none of them is a magic bullet. But we have had some good results with drugs like Saroglitazar. There are also new medications which aid in weight management by reducing the appetite and improving fat metabolism.
Why do you say that NAFLD is a huge problem in India?
Unfortunately our diet is laden with sweet and oily foods. Additionally, except for manual labourers and the fitness-conscious younger generation in cities, a majority of Indians are leading a sedentary lifestyle. Lastly, India is the diabetes capital of the world. Nearly 30 to 50 per cent of diabetics have fatty liver. So, these three conditions — dietary imbalance, lack of exercise and diabetes — are making NAFLD a much bigger health concern than thought.
