If alcohol consumption could impact the health of your liver, a sedentary lifestyle, a high calorie diet and excess fats associated with obesity and high blood sugar can be equally detrimental. That Non-Alcoholic Fatty Liver Disease (NAFLD), and its advanced form, Non-Alcoholic Steatohepatitis (NASH) cases are steadily rising is worrying doctors.
“We are used to hearing about alcohol-related liver damage; however, NAFLD is now steadily becoming a leading contributor to cirrhosis, liver transplantation, and mortality. It is extremely critical to educate the public on the fact that while excess alcohol causes damage to our liver, a sedentary lifestyle, overeating and a high calorie diet such as processed sugar is almost as bad as the damage from alcohol, making it an equal contributor to liver diseases today,” said N Murugan, Hepatologist and Transplant Physician, Apollo Hospitals.
Globally, the prevalence of NAFLD is estimated to be around 25% (22%-28%), while the prevalence in Asia is around 27% (22% – 32%), he said, adding: “However, we have seen the trend to be much higher in India with prevalence among adults at 39% and among children at 35%.”
“We have observed that among a cohort of over three lakh persons who underwent health checks at Apollo Hospitals in the last year – that includes both urban and rural population – 23% were found to have a fatty liver condition. Of these, three-quarters of the people did not have a history of consuming any alcohol, indicating that factors beyond alcohol consumption contribute significantly to this disease,” he wrote in an email.
NASH is an advanced form of NAFLD, R. Surendran, former director, Department of Surgical Gastroenterology, Government Stanley Medical College Hospital, pointed out. “Throughout the world, it is increasing at an alarming rate. About 6.5% of the total population had NAFLD irrespective of age and 20% of this has already gone into NASH. The prevalence of NASH will lead on to cirrhosis of liver and later, liver cancer,” he said.
He added that the difference between NAFLD and NASH was the presence of inflammation in the liver in NASH.
K. Premkumar, associate professor, Hepatology and director in-charge, Institute of Hepatobiliary Sciences, Madras Medical College and Rajiv Gandhi Government General Hospital, said that NASH was a wide spectrum of disease severity, including fibrosis, cirrhosis and hepatocellular carcinoma. “The global prevalence of NASH is estimated between two and six per cent in the general population,” he said.
Awareness of NAFLD remained low among patients and healthcare providers, he said. “It is an asymptomatic and slowly progressive disease, both in adults and in children, but fibrosis rapidly progresses in 20% of cases. It is diagnosed only when individuals undergo routine health screening or is incidentally detected during some other evaluation. This is the diagnostic challenge that we and patients face in the early stages,” he added.
Currently, NAFLD is increasing in India and is also becoming one of the important causes for end stage liver disease for which liver transplantation is the curative option, he observed.
“A major contributor for NAFLD in India are metabolic risk factors related to an inactive lifestyle and a high consumption of calories especially carbs and fats. In my personal experience as a liver transplant physician, the cases of NAFLD leading to transplants are almost at par with alcoholic liver disease-led transplants today,” Dr. Murugan pointed out.
Dr. Surendran said that it was alarming to see that 50% of diabetics, 75% of obese persons and 100% of obese and diabetics have NAFLD. Even non-obese people can develop NAFLD and NASH because of lack of physical activity and junk food. Childhood obesity is increasing at an alarming rate due to consumption of junk food, he said.
“As obesity, diabetes and hypothyroidism are the major players, controlling them would resolve this. Avoiding saturated fat, controlling weight and increasing physical activity are essential,” he said.