Liver ailments: Early indicators which are normally ignored, prevention suggestions

Fatty liver illness, also called steatosis, has emerged as a modern-day pandemic and a big non-communicable health downside akin to coronary artery illness. This situation entails the extreme accumulation of fats in liver cells, starting from easy fats deposition (fatty liver) to extra extreme varieties that trigger irritation and scarring (Non-alcoholic steatohepatitis or NASH) whereas excessive finish of spectrum is liver cirrhosis (irreversible liver scarring), resulting in liver cell failure, elevated liver stress or liver most cancers.

In an interview with HT Lifestyle, Dr Prakash Valse of Ruby Hall Clinic in Hinjewadi, shared, “Recent studies, such as the one presented at ENDO 2023, the Endocrine Society’s annual meeting in Chicago, Illinois, have shed light on the escalating rates of fatty liver disease over the past three decades. The burden of this condition is not limited to the United States alone; it poses a significant global health challenge. The risk of metabolic-associated fatty liver disease (MAFLD), formerly known as non-alcoholic fatty liver disease (NAFLD), has increased dramatically. This condition is closely linked to cardiovascular disease, type 2 diabetes, and a common form of liver cancer.”

According to him, diabetes and weight problems which are each on the rise worldwide, play a distinguished position in exacerbating the prevalence and severity of fatty liver illness. He mentioned, “Diabetes is one of the prime risk factors of fatty liver disease (50-85% prevalence in diabetes across various studies) and furthers the complications of fatty liver disease. Diabetics is more likely to develop rapidly progressive fatty liver disease, leading to permanent liver scarring (cirrhosis) and its life-threatening complications. Liver cirrhosis can cause liver cell failure, liver cancer, high liver pressure (portal hypertension), leading to ascites (fluid in the abdomen) and hepatic encephalopathy (liver coma) due to increased toxins reaching the brain.”

Asserting that recognising the signs of liver harm in diabetics is essential for early intervention, Dr Prakash Valse mentioned, “In the early stages of liver cirrhosis, the indicators can be nonspecific, including leg swelling, increased fatigue, changes in sleep patterns, easy bruising, weight loss, and anemia (low hemoglobin). Laboratory indicators may include low platelet count, hemoglobin, and WBC count, as well as mild elevation of liver enzymes and bilirubin in liver function tests. Abdominal ultrasound during health checkups may reveal a shrunken, nodular liver, an enlarged spleen, or fluid (ascites) in the abdomen.”

Cautioning that fatty liver illness has emerged as a potent danger issue for heart problems, additional amplifying the already substantial world burden of heart-related sicknesses, Dr Prakash Valse mentioned, “The coexistence of fatty liver and diabetes places individuals at a higher risk of developing cardiovascular complications, including heart attacks and strokes. This alarming correlation calls for heightened awareness and comprehensive preventive strategies to combat the growing burden of fatty liver disease. If left untreated, fatty liver disease can progress to life-threatening conditions, such as liver cancer and liver failure. The severity of fatty liver disease directly correlates with the risk of these complications. Therefore, early detection and intervention are critical in mitigating the adverse outcomes associated with this silent epidemic.”

In current years, NAFLD has emerged because the main reason for liver transplantation worldwide. Dr Prakash Valse mentioned, “The escalating prevalence of fatty liver disease, coupled with the shortage of available organs for transplantation, poses a significant challenge to healthcare systems globally. This underscores the urgent need for public health initiatives and policy measures aimed at prevention, early diagnosis, and effective management of fatty liver disease. Fatty liver disease has evolved into a modern-day pandemic with severe consequences for public health. Its strong associations with diabetes, obesity, cardiovascular disease, and liver cancer highlight the interconnectedness of these non-communicable health problems. As the global burden of diabetes and heart disease continues to rise, the prevalence of fatty liver disease is poised to exacerbate further. Thus, comprehensive efforts are necessary to combat this silent epidemic through early detection, effective management, and robust preventive strategies. By addressing the underlying risk factors and promoting healthier lifestyles, we can collectively strive towards reducing the impact of fatty liver disease on individuals and societies worldwide.”

Bringing his experience to the identical, Dr Kunal Adhyaru, Consultant – Hepatology, MBBS, DNB (General Medicine), MNAMS, Fellowship in Hepatology at SRV Hospitals in Dombivli, answered the next questions on liver ailments:

• Even average consumption of alcohol can have an effect on the liver so fatty liver is now labeled as MET-ALD as an alternative of NAFLD and AFLD for many who eat alcohol occassionally – Is this assertion true? Shed mild on this. What can forestall liver ailments?

Dr Kunal Adhyaru answered, “Yes, as per the latest scientific data, women are categorised as having Met-ALD if they consume more than 140 gm of alcohol per week, while for men, this threshold is more than 210 gm per week. This classification holds true when a metabolic condition such as diabetes, hypertension, dyslipidemia, or obesity is also present. Preventive measures against liver disease include weight loss in obese individuals and adopting a healthy lifestyle, which involves daily walking lasting between 30 to 45 minutes. It’s important to avoid alcohol, smoking, outside food – especially junk and processed foods and manage conditions like diabetes, hypertension and lipid levels. For those with MASLD (Metabolic dysfunction Associated Steatotic Liver Disease), vaccinations against HBV and HAV can be taken but only under the guidance of a Hepatologist.”

• Causes of early loss of life because of liver illnesses

Dr Kunal Adhyaru revealed, “Common causes of premature mortality encompass cardiovascular, kidney, and pulmonary complications, along with hepatocellular carcinoma, particularly in cases of long-standing liver diseases.”

• How to establish secure limits of alcohol consumption?

Dr Kunal Adhyaru insisted, “No amount of alcohol in any form is safe. Many individuals with alcohol-associated liver diseases experience improvement upon stopping alcohol altogether.”

• Early indicators of liver points which are normally ignored

Dr Kunal Adhyaru identified, “Early indications of liver problems, which are frequently overlooked, include discomfort or pain in the upper right abdomen, fatigue (especially in the afternoon) and jaundice.”

Dr Akash Shukla, Director – Hepatololgy at Sir HN Reliance Foundation Hospital in Mumbai, said, “The International societies have now recognised the growing importance of the synergy of the adverse effects of the combination of alcohol and metabolic dysfunction. The metabolic dysfunction includes presence of diabetes, insulin resistance, obesity, dyslipidemia, like high cholesterol and triglycerides, hypertension, etc. Those who have one of these risk factors and also consume alcohol are at much higher risk of developing fatty liver; and more importantly progression of fatty liver to hepatitis, and then finally cirrhosis and liver cancer as compared to somebody who has only one of these two.”

He urged, “If somebody is having alcohol, and they also have these factors, then the rate of progression is much higher. Similarly, somebody who has fatty liver because of metabolic dysfunction and then starts consuming alcohol, even if it is intermittent, lesser quantity, they are at higher risk of developing progressive liver disease and at risk of developing losses and liver cancer. Therefore, it is advisable that those who have a fatty liver, and have any of these metabolic dysfunctions, should strictly stay away from alcohol completely. Similarly, those who have a fatty liver must be very aggressive in controlling these metabolic risk factors to prevent the progression of the disease. If somebody has alcohol related problems, then it is important that not only they stopped alcohol consumption completely, but they also control their metabolic dysfunctions in order to prevent the progression of liver disease and keep the liver healthy.”