Docyard | The silent enemy

Fatty liver disease has emerged as a public health problem in India. We are referring to fatty liver that develops in people who take little or no alcohol. It is called as Non-alcoholic Fatty liver Disease (NAFLD). The disease is characterised by increased deposition of fat (triglycerides) in the liver. Nearly one in three adults in India has NAFLD. It is strongly associated with obesity, especially central obesity (pot-belly or increased waist circumference), and Diabetes.

Fatty liver disease behaves like any other chronic liver disease in the long run. In about one-third of patients with fatty liver, the disease progresses to cirrhosis (fibrosed or hard liver), end-stage liver disease (liver failure) and even liver cancer. This is especially for people who have Diabetes, abnormal liver function test as tested in the blood or increased fibrosis as measured by Fibroscan. Fatty liver not only increases the chances of liver disease and liver-related death but also increases the risk of heart attack, stroke, high blood pressure and certain cancers of the gut.

There are multiple metabolic mechanisms that lead to development of fatty liver. Insulin resistance is at the core of these metabolic pathways. All Indians are genetically susceptible to acquiring insulin resistance and developing fatty liver. Certain risk factors are strongly associated with NAFLD. These are obesity (BMI more than 25 kg/m2), central obesity (waist circumference more than 90 cm in men and more than 80 cm in women) and Diabetes. Increasing age (more than 40 years), male gender and increased liver enzymes are also known risk factors of the disease.

What to do if one is diagnosed with NAFLD?

An ultrasound of the abdomen is done for some diseases or as a health check-up that picks up fatty liver. In some situations, abnormal liver function test (LFT) leads to the diagnosis. One must consult a Gastroenterologist for further evaluation and advise. Certain tests will be done to assess the injury to the liver and severity of the disease, namely, LFT, viral markers and Fibroscan (quantifies the fat in liver and the extent of fibrosis). Presence of Diabetes, hypertension, dyslipidemia (high cholesterol/triglycerides) also needs to be checked. Other causes of fatty liver like alcohol, drugs, alternative medicine needs to be ruled out.

• Treatment: There is no proven drug therapy for fatty liver disease. The only proven measure is weight loss and life style modifications. Eating small portions of meals (hypocaloric diet), less fried food and fast food, less sugar intake and no alcohol. Regular moderate intensity exercise like brisk walk, jogging, cycling, swimming and other such similar activities are strongly recommended. High Intensity Interval Training (HIIT) and resistance training are particularly beneficial for dissolving excess fat in the body.

Drugs are used if lifestyle modification fails or there is significant fibrosis in liver as measured by Fibroscan. Drugs that have some benefit in reversing fatty liver are Vitamin E in non-Diabetics and Pioglitazone or Liraglutide in Diabetics. Atorvastatin and omega-3-fatty acids have also been tried on such patients.

• Prevention:  Maintaining an ideal body weight as per age and height is the best way to prevent fatty liver. Judicious eating, regular exercise, avoiding high sugar and alcohol intake are of immense help in avoiding fatty liver. Periodic health check ups for liver health are recommended.

Modifying lifestyle to include judicious hypocaloric diet and regular exercise not only prevents but is also the only proven therapy for fatty liver disease.

The Writer is Dr (Air Cmde) Bhaskar Nandi Director & HOD, Centre for Liver & Digestive Sciences at Sarvodaya Hospital & research Centre, Sector 8, Faridabad