International NASH Day was held on 12th June since last year to raise awareness and urgency about fatty liver disease (NAFLD) and its more advanced form, nonalcoholic steatohepatitis (NASH) which affect more than 11.5 crore people around the world. Fatty liver disease and NASH is common disorder and usually unrecognised which has risk of progression to cirrhosis, liver failure or liver cancer. As part of international awareness program Dr Vishal khurana (Senior consultant Gastroenterology of Metro Hospital Faridabad) explains about fatty liver diseases and its sequales.
Fatty liver is a condition where excess fat is deposited on this organ. Also called as steatosis, this condition happens when more than 5- 10 percent of the weight of the liver is made up of fat. Fatty liver is a common condition among people. A study from coastal regions of India found ~ 25% of healthy persons had patients had fatty liver on ultrasound.
It can occur at all ages including childhood, highest prevalence is in 40–50 year age group. Prevalence is more in person who are obese or diabetic.
Predisposing factors are Diabetes mellitus, Obesity or being overweight, Hyperlipidemia or the condition where there are high levels of fat in the blood, Genetic reasons, Rapid loss of weight, medications (like Aspirin, steroids, tamoxifen, tetracycline etc), Hepatitis C infection, celiac sprue and Wilson disease
Types of Fatty Liver
1. Alcoholic fatty liver: This condition occurs when there is a heavy consumption of alcohol. Gastroenterologists recommend abstention from alcohol for this condition to subside. If the patient continues to consume alcohol, then liver cirrhosis may develop.
2. Non alcoholic fatty liver (NAFL): One may develop a fatty liver even if one is not an alcoholic. The liver in some cases is unable to process the fat in cells causing them to build-up on the organ.
a. When more than 10% of the liver is made of fat then this condition is called Non Alcoholic Fatty Liver (NAFL).
b. Non alcoholic steatohepatitis (NASH): When fatty liver is associated with inflammation in liver patient is said to be having Non alcoholic steatohepatitis. NASH is a more advanced stage of NAFLD, and has a higher risk of progressing to liver cirrhosis or hepatocellular carcinoma (HCC). These condition display symptoms like jaundice, vomiting, nausea, loss of appetite and abdominal pain. Blood test (LFT) shows raised enzymes level. Approx 5-8% of the Indian population has NASH. Consult a doctor if you are experiencing any of these symptoms.
3. Fatty liver during pregnancy: Occurring mainly in the third trimester, the symptoms of this condition are vomiting, nausea, pain the right part of the abdomen and jaundice.
During the early stages (fatty liver) of the disease, patients usually have no symptoms directly related to liver disease. However, people may experience a vague abdominal discomfort. If their liver is inflamed (NASH) then they may display symptoms of poor appetite, weight loss, pain in the abdomen and fatigue.
· The doctor can advise blood test (Liver function test), USG abdomen, Fibroscan, etc to know about fatty liver and its seriousness.
· About 20 percent of people with nonalcoholic steatohepatitis will progress to cirrhosis.
· The main complication of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis is cirrhosis, which is late-stage scarring (fibrosis) in the liver. Cirrhosis occurs in response to liver injury, such as the inflammation in nonalcoholic steatohepatitis If the process isn't interrupted, cirrhosis can lead to fluid buildup in the abdomen (ascites), swelling of veins in your esophagus (esophageal varices), which can rupture and bleed, confusion, drowsiness and slurred speech (hepatic encephalopathy), Liver cancer, End-stage liver failure, which means the liver has stopped functioning
Prevention and reversal of fatty liver disease
· There are no medical or surgical treatments for fatty liver, but some steps may help prevent or reverse some of the damage.
Fatty liver is currently the focus of intense research. Scientists are studying whether various medications can help reduce liver inflammation, including new diabetes medications that may help you even if you don’t have diabetes.
In general, if you have fatty liver, and in particular if you have NASH, you should:
· lose weight – safely. This usually means losing no more than half to one kilogram (one to two pounds) a week
· lower your triglycerides through diet, medication or both
· avoid alcohol
· control your diabetes, if you have it
· eat a balanced, healthy diet
· Exercise: increase your physical activity. Exercise atleast 5days of the week.
· Get regular check-ups from a doctor who specialises in liver care.
As a part of awareness program there will be organization of Free Fibroscan and Liver function test on 24thJune 2019
Dr Vishal Khurana
MBBS, MD, DM (Gastroenterology), MNAMS
Senior Consultant Gastroenterology