Chennai
The damage which happens at liver tissue level through the stages of fatty liver, fatty hepatitis and liver scarring is silent until very late stage where liver function dips. This entire injury happens over a span of 2 decades or more. NAFLD and MS are increasingly recognized health problem in the community. It has emerged as the commonest cause of abnormal liver enzymes. NAFLD increases the risk of type 2 DM and vice-versa. Unrecognized steatosis may lead to NASH and eventually to cirrhosis. There is an urgent need to address this growing epidemic.
Most of the time in countries like India where screening programs are not active, liver cirrhosis is detected at a stage when patient needs liver transplant to survive. This underlines the necessity to undergo screening to detect this silent epidemic and arrest progression into late stages of liver scarring and liver cancer. Once significant liver scarring or liver cirrhosis sets in; reversibility cannot be guaranteed.
Prevention is the way to go-early detection of the silent liver disease and treatment before permanent damage sets in should be aimed at. Nowadays, is not uncommon to find youngsters in their thirties developing liver cirrhosis. “Alcoholism which begins in campuses (and even schools!) clubbed with genetically linked lifestyle liver disease namely NAFLD probably is the reason behind this alarming phenomenon. Creating awareness among young generation, from school days onwards regarding how over nutrition, lack of exercise along with abuse of alcohol is the way to go to curb this liver health crisis, “said Dr Hari Kumar R Nair, senior Consultant Hepatologist and Liver Transplant Physician, Gleneagles Global Health City.
In India, paradoxically economic evolution in our country has gifted few lifestyle illnesses with far reaching consequences and health care burden. Rising affluence, changes in lifestyle, junk food habits, obesity and rising incidence of diabetes have all contributed in varying degrees to the “lifestyle health crisis”. Sedentary lifestyles clubbed with high liquor consumption is a problem in urban setting which results in metabolic imbalance, diabetes and ultimately various organ damage, said Dr Hari Kumar.
Non-alcoholic steatohepatitis (NASH) is the worst form of fatty liver seen in 10% of patients with fatty liver. It is a progressive condition characterized by inflammation of liver leading to cell death! Long standing inflammatory milieu leads to fibrosis (liver scarring) and eventually to cirrhosis. Studies show that many cases of cirrhosis of unknown cause are probably due to ‘burnt out’ NASH. In addition, NASH cirrhosis increases the risk of hepato cellular carcinoma by several folds.
“Non-alcoholic fatty liver disease is another important health issue of concern even in youngsters these days. Though most of the liver related ailments can be prevented, it can mostly happen due to lifestyle modifications such as regular exercise, avoiding alcohol consumption and a healthy diet intake,” says Dr Chandan Kumar, senior consultant hepatologist and transplant physician, Kauvery Hospital.
Treatment of NASH / NAFLD
Right now, there are no drugs proven to reduce NASH. Current therapy is multi-dimensional approach such as life style modification, weight loss, change in dietary habit and exercise. Weight loss of 5-10% over 6 months has been shown to improve NAFLD and obesity.
Diet High calorie intake and diet rich in carbohydrates and saturated fats should be avoided. Most of the fast-foods contain trans-fat which has been shown to worsen liver injury and increase hepatic triglycerides. Therefore, they should be avoided. Poly unsaturated fatty acid seem to improve liver enzymes and are recommended. Many soft drinks contain fructose that increases lipogenesis, insulin resistance and NAFLD.
Exercise Both the ‘brothers’ are susceptible to exercise. It helps weight reduction, improvement in liver enzymes and |decreases the risk of type 2 DM. Moderate exercise with expenditure of at least 400 calories for 3-4 times a week has shown to improve NAFLD in the short term.
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