It all depends on the liver!

Fatty liver is found in one among five individuals in India, and most of them consider it normal, though it is not really so. Fatty liver is due to excess fat within the liver, which, if not controlled, can lead to inflammation, scarring at a later stage, liver cirrhosis. With 30 per cent of the population suffering from incidence of severe fatty liver, it is a cause for concern explains Professor Dr Tom Cherian, Senior liver transplant surgeon.

Q1. How is fatty liver defined? What causes fatty liver?
Fatty liver is when the amount of fat within the liver exceeds its normal level. While up to 10 per cent of fat within the liver is termed mild, and 10-30 per cent moderate, over 30 per cent is severe and this requires medical attention. Non-alcoholic fatty liver disease (NAFLD) is the scientific name for ‘fatty liver’. By definition, these are people who do not abuse alcohol. Although most patients with NAFLD have only simple fat within the liver cells, a portion of patients develop progressive disease characterised by fat, with an ‘inflammatory’ component known as non-alcoholic steatohepatitis (NASH). The latter is strongly associated with the development of liver scarring and finally, liver cirrhosis.    

Q2. How can NAFLD be identified? Are there any obvious symptoms that people must look out for?  
Bleeding from the intestines or elsewhere, itching, jaundice (yellow skin and eyes), ascites (water within the abdomen), are some symptoms that suggest the presence of advanced liver disease or cirrhosis. But it must be noted that early fatty liver is virtually symptom free. It is only during the advanced stages that it gets identified in patients. Although liver biopsy is the only method of confirming the presence of NAFLD, basic blood tests and a good quality ultrasound can warn of the presence of this disease in most patients before symptoms. However, those who are obese or diabetic must check their livers once a year via ultrasounds and blood tests.

Q3. With diagnostics now being done regularly is it being identified early?
In recent times, it is not unusual for someone to have an incidental ultrasound report that says ‘grade 1 or 2 fatty liver’. In fact, it is so common that many people think it is not a serious abnormality and can be ignored. However, this is not true. A recent study confirmed that liver transplantation for fatty liver now represents the fourth most common reason for transplantation in patients.     

Q4. At what stage is fatty liver disease irreversible?
In the early stages (grade 1 to 3), early intervention can reverse the process of the disease. But once cirrhosis sets in, in most cases even if the injury is removed, further progression and symptoms is likely. NASH may progress to cirrhosis in 9-20 per cent patients, of which one-half will develop symptoms within seven years. Non-alcoholic steatohepatitis (NASH) is also clearly associated with the development of liver cancer. Liver transplantation (LT) is the management of choice in such patients and the outcomes are excellent with 1- and 5-year survival rates in 80 per cent of the patients.

Q5. How much is the incidence in India of non-alcoholic fatty liver disease?  
Due to obesity, hypertension and diabetes mellitus, the prevalence is found to be as high as 45 per cent. Carbohydrates, in the form of rice, are a central component that can lead to accumulation of triglycerides within the liver. This process, overtime, leads to significant liver scarring and eventual progression of disease. It is a preventable disease if people take the right steps in time.

Q6. Can you share a few tips on how to maintain good liver health?
Following are some important aspects that people must take care of
1. A good diet and exercise to prevent obesity.
2. Refrain from regular and excessive alcohol (an occasional drink e.g. one glass of wine once a fortnight does not hurt).
3. Ensure good sugar level control if diabetic.
4. Get vaccinated against deadly liver viruses like Hepatitis B.