Early diagnosis can reverse fatty liver

The recent news about filmmaker Rajesh Pillai, who died of non-alcoholic liver cirrhosis, has put the spotlight on NAFLD, which doctors say has been emerging as an epidemic. Dr B S Ramakrishna, Senior Consultant, Gastroenterology, SIMS, insists that not everybody with NAFLD will progress to cirrhosis. 

“There is a sub-section that has non-alcoholic steato hepatitis (NASH). It is a more advanced stage of NAFLD, and has a higher risk of progressing to liver cirrhosis as there is degeneration and inflammation in the liver. This is one of the major reasons for liver transplant,” he says. 

A study published online recently by the Indian Society of Gastroenterology revealed the prevalence of NAFLD in around 9 per cent to 32 per cent of the general population in India with higher prevalence in those who were overweight or had obesity and those with diabetes or pre-diabetes. 

The study also noted that published literature on NAFLD from India was sparse since the condition has been recognised fairly recently.

Cirrhosis has always been associated with excessive consumption of alcohol. However, changing lifestyles and dietary patterns have been rendering a section of men and women at risk of contracting the condition. Dr Joy Varghese, hepatologist, Global Hospitals, says, “I have been seeing a number of cases — both men and women — with NASH. 

Earlier, we used to see middle aged people with NAFLD. Now, even children have it,” he says. Overweight people and diabetics are at risk, he adds. “In the south, there is high intake of carbohydrates in the form of rice and other variants, like idli and dosa. As a result, excessive carbs convert into fat and are deposited in the liver,” he says. 

Dr Varghese adds that while diabetics with sugar rates under control are not at risk, diabetics with sugar levels exceeding 200 are at greater risk. Dr Varghese adds, “Thyroid, high cholesterol and obesity increase the risk. People with a body mass index above 30 have fatty liver.” 

Dr N Murugan, hepatologist, Apollo Hospitals, notes that those with metabolic syndrome face a risk of the condition. He says, “Metabolic syndrome is a combination of parameters like high triglycerides, lower levels of good cholesterol, high blood pressure, central obesity and diabetes.”  He also adds that NASH may not be a recent phenomenon. “Earlier, we probably didn’t know why a person died, but now, with improved diagnostic capabilities, we are able to spot it.”

Dr Varghese adds that while fatty liver may be rampant, the treatment is completely affordable and the condition reversible. “The good news is that you need not spend a lot on medicines. One can also manage it with diet and regular exercise. It can be reversed, when diagnosed early,” he says. He adds that acceptance is important for effective treatment and results. 

“Most often the problem is poor acceptance levels among the patient population; they are not ready to modify their lifestyles,” says Dr Varghese. Dr Murugan adds that with newer techniques to assess the liver condition like FibroScan, there is scope to diagnose the problem early and correct the risk factors.

CAUSES:  NAFLD is part of the metabolic syndrome characterised by diabetes, or pre-diabetes (insulin resistance), being overweight or obese, elevated blood lipids, such as cholesterol and triglycerides, as well as high blood pressure. Not all patients have all the manifestations of the metabolic syndrome.

Non-alcoholic fatty liver disease (NAFLD) is a very common disorder and refers to a group of conditions where there is accumulation of excess fat in the liver of people who drink little or no alcohol. The most common form of NAFLD is a non-serious condition called fatty liver. In fatty liver, fat accumulates in the liver cells. Although having fat in the liver is not normal, by itself it probably does not damage the liver.