The silent Pandemic

Everyone is now well versed with word ‘pandemic’ thanks to Covid pandemic raging across the world. “Pandemic” is a disease that’s affecting people across the world irrespective of their age, gender and race. But most of us are unaware of the ‘silent pandemic ‘we are seeing in the past 3 decades which will slowly but surely extract a toll 20-30 times higher than corona albeit in a slow , silent yet equally deadly manner. That is the fatty liver pandemic also called as NAFLD ( non- alcoholic fatty liver disease) This month is observed the world over as NASH ( Non alcoholic steatosis-hepatitis) month to improve public awareness of this pandemic. Alcohol and certain medication also cause fatty liver but the NAFLD is primarily a diet and lifestyle disease. Lets talk percenages . When more than 5 percent of your liver cells are replaced by fat it’s called fatty liver. Fatty liver is usually picked up on ultrasound which detects liver as fatty when 30 percent of liver cells are replaced by fat. The prevalence of fatty liver in our general population is about 30 percent that is one out of 3 people has fatty liver. In urban pockets it’s as high as 40-50 percent i.e every other person. So do we all need to panic ? Majority of people with fatty liver will NOT have serious outcomes .However 8-16 % of fatty liver patients will have NASH ( Non alcoholic steatohepatitis). NASH means the fat in the liver is causing injury inflammation and eventually scarring of liver. NASH is suspected on liver function test and confirmed by tests like Liver elastograpgy and liver biopsy. Now NASH has potentially serious implications. Some patients with NASH ( about 10 percent every decade) will develop liver cirrhosis leading to end stage liver disease and liver cancer both of which are serious outcomes of NAFLD. This ( development of cirrhosis and liver cancer) is a slow and silent process that may take 10-20 years during which patient does not have any symptoms . Diabetics and morbidly obese Pts ( BMI >35 ) with fatty liver are higher risk of NASH compared to non diabetics. In these groups one out of 3 fatty liver Pts have NASH three times higher than non diabetics Therefore even though only a small fraction of fatty liver patients develop life threatening outcomes like cirrhosis and liver cancer -the denominator ( all patients with fatty liver ) is so big that that the disease burden in the coming years due to NAFLD is huge. Two decades ago the leading causes of liver disease and indications for liver transplantation used to be alcohol intake ,hepatitis B and hepatitis C . All these are overtaken by NAFLD in the past 2 decades which is now leading cause of liver disease and liver cancer. Most of us have only fatty liver with no evidence of NASH with no risk of serious liver problems. So ‘ All is well ?“ No, fatty liver has other implications as well. Asians especially men are prone to the ‘syndrome X’ or ‘metabolic syndrome’. Metabolic syndrome is a group of riskf actors that includes central obesity , insulin resistance with type 2 diabetes , deranged lipid profile with high triglycerides ,LDL cholesterol, Hypertension, coronary artery disease with heart attack and stroke in young along with NAFLD. Also PCOS in women. There is some genetic and racial predisposition for metabolic syndrome but essentially it is a diet and lifestyle related disorder. So having a fatty liver on ultrasound indicates that you are in the cohort for the ‘metabolic syndrome’ secondary to a calorie imbalance in with too much calorie intake and too little being spent. In addition to a sedentary life style this is also secondary to excess carbohydrate intake in diet. This is contributed not just by sweets, juices and alcohol but also all types of processed foods made of wheat , maida , rice flour , corn flour etc your fritters, haldirams , cookies and various other comfortfoods. . So the fatty liver is infact a ‘ redflag ‘ for metabolic syndrome which makes a person prone for all the lifestyle diseases dicussed above in addition to colon,pancreas ,endometrial and other ancers. What do we do about fatty liver? Finding a Fatty liver during your annual health check is not a reason to panic but a wake up call asking you to adjust your lifestyle and diet in the years to come. The goodnews is that you have ample lead time to adjust your lifestyle and your diet as fatty liver takes more than a decade to cause major health problems. This includes more exercise, physical activity, avoiding stress eating, diet rich in protein, lean meats, greens, salads and fruits with a low glycemic index. Though doctors can give medication to reduce inflammation in NASH the only effective and sure fire way to reverse fatty liver is dietary and life style changes Medical and surgical management of fatty liver: Patients with fatty liver who have NASH (inflammation in liver) need specialist treatment. NASH is suspected on liver function tests and confirmed by tests such as liver elastopgraphy, liverbiopsy in selected patients. The doctors can prescribe hepato-protective drugs like as vitamin E, ursodeoxycholic acid and PPAR agonists to reduce inflammation but the only effective way is sustained weight loss through diet and lifestyle changes. Patients with morbid obesity (BMI . 32.5) with NASH and associated obesity related health issues such as tyoe 2 diabetes, dyslipedimias are ideal candidates such as bariatric surgery. In patients with longstanding NASH with severe liver scarring leading to cirrhosis need to be in close follow up with a liver specialist and may eventually need a liver transplantation. NASH predisposes to liver cancer so patients with documented chronic liver disease secondary to NAFLD need to periodic 6 monthly check up with liver scan and tumor markers to detect liver cancer an early stage KEY POINTS ( can arrange the in text boxes which are in relevant paragraphs) NAFLD affects more than one-third of world population NAFLD can lead to chronic end stage liver disease and liver cancer NAFLD is a risk factors for many other diseases like type 2 diabetes, coronary artery disease. The only proven effective way to reverse NAFLD is dietary and lifestyle changes Dr Phani Krishna MS(JIPMER) MRCS (Edin) MCh (SGPGI)FLT (Leeds) Surgical gastroenetologist , GI cancer and liver transplant surgeon #drphanikrishnaRavula #Liverproblems #laparoscopicsurgery #gastrodoctor #gastroclinic #besttreatment #besthealthcare #treatment #Prevention For more visit: http://www.drphanikrishnagastro.com https://www.facebook.com/DrPhaniKrishna.SurgicalGastroenterologist https://www.linkedin.com/in/phani-krishna-ravula-a5595820/ https://twitter.com/ravula_phani