Fatty Liver Disease: Prevention is better than cure

Dr Vandana Sharma
Nonalcoholic fatty liver disease (NAFLD), also commonly known as fatty liver (I will be using this term in the rest of the article for familiarity) is quickly growing as a leading cause of liver disease. As per the most recent statistics, this disease now affects almost one fourth of the world’s population (25% or 1 in 4 adults) and is also a known cause for liver cancer. In simplest terms, fatty liver is defined as presence of fat in the liver tissue with no other cause for fat accumulation there, such as genetic factors, alcohol or medication use etc. The question arises, if fat is everywhere in the body, so why is liver fat such a big deal? Well, this is a grave problem because fat accumulation in the liver causes inflammation and slowly leads to fibrosis of the liver. In other words, when the liver tissue converts into fibrous tissue, it is not capable of doing its vital functions such as removing toxins from the blood and producing proteins some of which help with blood clotting and maintaining immunity to just name a few. Liver is the largest internal organ of the body that is the primary site of synthesis and metabolism of several proteins, hormones, digestive juices, lipids and carbohydrates, while excreting the toxic waste from the bodily metabolism. Therefore, the importance of having a healthy liver can’t be overemphasized, it would almost be analogous to calling it as the powerhouse of the body which if damaged or replaced by non-functioning fat or fibrous tissue can lead to a shutdown of many functions that are vital to life.
Fatty liver has is a rising incidence among the young adults and parallels an increase in obesity, diabetes type 2 and high cholesterol, also known as metabolic syndrome. Non-alcoholic Fatty Liver disease is now being renamed as Metabolic dysfunction associated steatotic liver disease (MASLD) due to its close association with the metabolic dysfunction. While fatty liver is at one end of the spectrum in disease progression, advanced stages of fat accumulation and fibrosis in liver cells leads to liver cirrhosis. The biggest irony in this whole progression is that it can be a completely silent process from the beginning to advanced cirrhosis stage! Yes, I repeat, the patients may not have any signs of this disease until the signs of frank liver failure ensue!
Bringing the context to our Jammu, clearly something is wrong with our lifestyle even when vast numbers among us proudly boast non-alcoholic, non-smoker, vegetarianism. There are certainly some factors leading to this silent liver disease we are astoundingly unaware of. Even though I do not have the numbers to provide the statistics in Jammu, but the rising incidence is clearly visible in the common population.
Through this article I intend to uncover some of the food fads and emphasize healthy lifestyle choices that are critically needed to curb this epidemic of fatty liver and metabolic dysfunction.
Importance of maintaining a healthy weight
Maintaining a healthy weight is one of key attributes of healthy ageing. Obesity is a known risk factor for multiple medical problems including diabetes, coronary heart disease, stroke and is a component of metabolic syndrome. Not surprisingly, obesity especially increased belly fat (also known as visceral fat) is one of the strongest contributors to non-alcoholic fatty liver disease and to all the above. As per the American liver foundation, a diagnosisof fatty liver disease should automatically trigger evaluation for heart disease due to similar associated risk factors for both.
On the brighter side, a reduction in belly fat can reverse early fatty liver disease. I would really want to emphasize this statement. In other words, having excess fat around the belly area should raise an alarm for all the conditions listed above, also knowing that taking care of one key problem (obesity) could avert many others. In general, hepatologists would recommend average 5-10% reduction in body weight with progressive fatty liver disease. For example, if someone weighs 100 kg, a 5-10% reduction in weight would mean losing 5-10 kg of weight to reverse some of those changes. This can be a daunting task, especially when we find ourselves stuck in the wheel of modern sedentary lifestyle, paucity of time to exercise or even cook leading to poor eating habits, and sometimes the fascination of following others who seem to be “enjoying life”.
Diet and lifestyle changes:
The generation X and millennials in India seem to be most affected by the obesity epidemic and not surprisingly, suffering the most from metabolic syndrome and associated diseases. There are several factors responsible for this, but most concerning issue is IGNORANCE! Ignorance about making the right lifestyle and dietary choices when it comes to spending our time and money. This may be driven by blind obsession with the super stores selling easy pre-packaged highly processed meals, that seem like an easy alternative to freshly cooked food. Have you ever noticed that the sales of “ready to cook/ready to eat” food have doubled in the last 5 years in India? These food packets are laden with everything sans the nutrition: excess salt, fat, sugar and preservative chemicals, that our liver metabolizes and removes.
Imitation of cheaper western food habits but not their active lifestyle is leading us towards the obesity epidemic. Junk food chains like KFC and McDonalds were warmly welcomed in our country nearly three decades ago and their popularity and business only grew since then.Now, this is a super-easy question for everyone: What looks more attractive on social-media posts – eating out at a popular restaurant OR visiting Sabzi Mandi and cooking dal-sabziat home? Can we somehow change the norm and make the second option look more attractive by emphasizing what we are potentially bringing home by eating out?
An easy tip is to just critically analyze what goes on our plates and consciously reminding ourselves about the hazards of eating fried, processed food rich in simple carbohydrates, unhealthy fat and sugar. A simple habit of not buying or preparing sugary cold drinks during summer, may save you hundreds of empty calories from sugar which would otherwise be accumulating in the liver cells. The seemingly real juice boxes are not actually real, one cup may contain added sugar worth entire two day’s requirement. We are overburdening our body system, especially the liver unknowingly with so much sugar, fat, excess carbohydrates that it is impossible for the body to metabolize it and resulting in fatty liver. I would highly recommend watching the famous Netflix documentary – “Forks over Knives” which highlights some of these often-ignored facts about the diet that is leading to a diseased population.
Realizing the problems with their conventional high fat diet, the western countries are making a shift towards plant-based diet, piling bigger portions of fresh fruits and vegetables on their plates. Their lifestyle in general is geared towards physical activity through sports, outdoor activities or targeted exercise/gym sessions which unfortunately is critically lacking among us. This is also something we find very hard to inculcate as adults as we didn’t grow up playing sports, our childhood was trapped indoors dealing with ferocious academic competition, still remember sports class in school was considered the time to catch up with friends and not play!
The second lifestyle change that is critically needed in our society is increased physical activity. One of my endocrinologist friends once said, “Sitting is the new Smoking”, I totally believe in what she said. It’s high time we take a step back, back to including yoga and ayurvedic principles in our lives, guiding our younger generation to live their life better by adopting healthier lifestyle early in childhood, preventing childhood obesity so it doesn’t bother them as adults, emphasizing routine physician visits for disease screening and not just when we are ailing.
Regular physician checkups:
Having scheduled yearly physician check-ups even when nothing is wrong can save us multitude of medical problems. No, I am not telling you to go looking for troubles, but it’s better to find out a problem early than late when it can’t be managed. We typically seek treatment of a disease when it’s obviously bothering us which sometimes may be too late. In contrast, in most developed countries the focus is on disease prevention and early diagnosis and screening. Regular checkups can not only prevent some of the common diseases but sometimes bigger problems such as organ damage and cancers. So, making it a ritual to visit your physician once a year will only make you healthier and aware of yourselves. Diseases like chronic fatty liver disease can totally be prevented and reversed in early stages, but once cirrhosis develops, there is no treatment to reverse it other than liver transplant.
(The author is Associate Professor of Anesthesiology Director Pain Medicine Service Program Director Pain Management Fellowship Program State University of New York, Upstate Medical University Syracuse, NY)

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