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On International Fatty Liver Day (International NASH day), Dr. Harikumar Nair MD, DM, MRCP (UK), FRCP (Edin), who is a consultant at Gleneagles Global Health City, Chennai and Kinder Hospital, Kochi, writes on how modifying your lifestyle can help beat the Fatty Liver Disease that has affected even children.

Karma follows you! Though it originated in Asia, this has become a common usage in the eastern and the western societies. If any medical condition falls into karma principle, it is none other than “Metabolic syndrome” and associated fatty liver disease. Sedentary lifestyle and over eating are the karma elements responsible.

Thirty per cent is the prevalence of this disease globally. In India, Kerala recently reported a prevalence of 49 per cent and a staggering 60 per cent prevalence among obese school going children. This problem used to be reported in the West few decades ago, that too among the affluent. Now it is increasingly being reported in Asia. The economy is improving, purchasing power is on the rise and, as a result, people eat more and drink more.

Agrarian economy has given way to professional streams such as information technology with much less opportunity to engage in physical exercise. Consumerist Kerala, which thrive on NRI remittances, happens to be a fertile land for metabolic syndrome and fatty liver.

Fat does accumulate in the liver in those who consume alcohol, but those who engage in faulty lifestyles also develop Non-Alcoholic Fatty Liver Disease (NAFLD). This is primarily contributed by mismatch between the food energy which we consume and the level of physical exercise which should ideally burn off the food calories. Intake and output should match. When this process does not happen, excess food calories get transformed into fat and is deposited in the liver.

This lifestyle liver disease is usually seen with diabetes, hypertension and high cholesterol levels. In advanced stages heart disease and stroke also gets tagged on. The whole morbidity bundle follows the same karma kitty of sedentary lifestyle and over eating. Recent studies point towards the fact that genetic reasons and racial differences also contribute to this problem; specific genes like PNPLA3 have been identified which predisposes individuals to diabetes and fatty liver disease.

Now, what are the consequences of fatty liver disease?

Fatty liver disease evolves in three stages.1. Bland fatty liver; 2. Fatty Hepatitis; 3. Liver cirrhosis and Liver cancer. To begin with bland fatty liver remains silently for one or two decades. Gradually liver cells (Hepatocytes) get irritated by the presence of fat and lead on to swelling of liver cells (Fatty Hepatitis-Steato Hepatitis) and ultimately Scar tissue (fibrosis) accumulates. This scar tissue formation progresses on to liver cirrhosis and cancer as well. This slow progression over two or three decades can be largely silent.

The patient becomes aware of the disease only when it has advanced into cirrhosis and cancer. Cirrhosis is a “no go back” stage; more over treatment modalities at this stage including liver transplantation are expensive. Identifying this problem at the asymptomatic phase gives an opportunity to halt progression or even cure fully. Unfortunately, such people with asymptomatic Fatty Liver Disease may not reach a medical facility.

What’s the way forward?

No magic potion is available to prevent fat getting accumulated in liver or to prevent the liver cells getting swollen up and consequent laying of liver scarring. More than 10 medicines are in the various stages of rug research, but have not reached the market.

Modifying your lifestyle is the solution at this point of time. Regularising one’s lifestyle is the mainstay of treatment. Matching food intake with one’s level of physical exercise is the key. Exercise of a minimum 40 minutes of aerobic exercise, either brisk walking, cycling, jogging or swimming, is the step to take at this time. One should carry out an audit of food intake. Avoiding overeating and engaging in regular physical exercise are the strategies to adopt.  There is an urgent need for public health education, which should ideally start from schools where the focus should be on balancing lifestyles.


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