liver074446
KOCHI:Kerala has achieved improvements in material conditions of living, reflected in indicators of social development, comparable to those of many developed countries. Achievements such as low levels of infant mortality and population growth, and high levels of literacy and life expectancy, along with the factors responsible for such achievements have been considered characteristic results of the popularly known Kerala. Even though Kerala has long been known for spectacular feats in the field of health and boasting of social development indicators comparable to developed countries, an alarming increase in cases liver diseases is threatening to put its reputation in jeopardy.
Liver is one of the largest glands in our body and its main function is to assist in regulating the process of digestion. It also helps in eliminating toxic substances from the body and in removing dead Red Blood Cells , helps immune mechanisms to thwart infections in addition to regulating metabolism of sugar, protein and cholesterol in the body. Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly.
According to the World Health Organization (WHO), liver diseases are 10th most common causes of death in India. Over 2 lakh people lose their lives every year in India due to liver disease, one in every five Indians suffers from liver problems and the most frequent causes are alcoholic liver disease, Hepatitis B, Hepatitis C and obesity-related liver disease. There has been a paradigm shift in the dynamics of liver cirrhosis and about 10 lakh new patients are diagnosed with it every year in India. It is difficult to get a figure of those affected by liver diseases in Kerala. But chronic liver diseases, including cirrhosis, are now fast catching up among Keralites like other lifestyle disorders, including diabetes and hypertension. According to a recent study, 5000 to 10,000 people die every year in the state due to liver diseases, compared to the national average of 70,000.
Sedentary lifestyles, eating habits like consumption of junk food, high-fructose drinks, less consumption of proteins, lack of physical activity clubbed with high liquor consumption are the most important factors. Moreover obesity and rising incidence of diabetes and other lifestyle disorders have all contributed in varying degrees to this crisis,
Alcohol still remains the major cause of liver disease in India and especially in Kerala The state, which has a high per capita consumption of alcohol, India's highest per capita alcohol consumption, at more than eight litres per person per year which is double the national average.
But alcohol alone is not the only cause. Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver dysfunction worldwide and is a rapidly growing health problem in regions such as the Middle East, Far East, Africa, the Caribbean, and Latin America. Nonalcoholic fatty liver disease (NAFLD) is emerging as an important cause of liver disease in India.
Non-alcoholic fatty liver disease (NAFLD) is the term for a wide range of conditions caused by a build-up of fat within the liver cells. A healthy liver should contain little or no fat. Most people with NAFLD only carry small amounts of fat in their liver, which doesn't usually cause any symptoms. This early form of the disease is known as simple fatty liver, or steatosis. Simple fatty liver is very common in India reflecting the number of people who are obese or overweight. It is one of the most common forms of liver disease, with an estimated 30-40%% people in India having early forms of NAFLD. In most people, simple fatty liver is unlikely to cause harm, but that doesn't mean it's not a serious condition.
NAFLD progresses through various stages before progressing to end stage liver disease. The stages are described below.
Stage 1: Simple fatty liver (steatosis)
Hepatic steatosis is stage 1 of the condition. This is where excess fat builds up in the liver cells, but is considered harmless. There are usually no symptoms, and you may not even realise you have it until you have had an Ultrasound scan test.
Stage 2: Non-alcoholic steatohepatitis (NASH)
Only a few people with simple fatty liver go on to develop stage 2 of the condition, called non-alcoholic steatohepatitis (NASH). It is estimated that around 5-8% of the Indian population has NASH. NASH is a more aggressive form of the condition, when the liver has become inflamed. Inflammation is part of the body's response to injury, which suggests that cells in the liver are being damaged and that some liver cells are dying.
Stage 3: Fibrosis(scarring of liver)
Some people with NASH go on to develop fibrosis, which is where persistent inflammation in the liver results in the generation of fibrous scar tissue around the liver cells and blood vessels. This fibrous tissue replaces some of the healthy liver tissue, but there is still enough healthy tissue for the liver to function normally.
Stage 4: Cirrhosis( chronic liver disease)
This is the most severe stage, where bands of scar tissue and clumps of liver cells develop. The liver shrinks and becomes lumpy (known as cirrhosis).
However, this can happen much earlier in some people. Fatty liver is often found among people in the age group of 25 to 40 and if not addressed in time, it will progress to cirrhosis by the age of 50 to 65 following many years of liver inflammation associated with the early stages of the disease. Once the patient is diagnosed as cirrhotic, there are very less chances of reversal of the disease, Cirrhosis is associated with other complications such as ascites (fluid build-up in the abdominal cavity), hepatic encephalopathy, chances of variceal bleeding and other infections. Once these complications begin, the maximum a patient can survive without a liver transplant is 2 to 3 years
Non-alcoholic fatty liver disease is considered a manifestation of the metabolic syndrome and thus occurs frequently with the other manifestations of the syndrome( diabetes, hypertension, hyper cholesterol and obesity). Occasionally it may occur without the other abnormalities of the syndrome.
So you are more likely to develop NAFLD and more severe forms of the disease, such as NASH, fibrosis or cirrhosis if you are obese or overweight, have type 2 diabetes, have high cholesterol, are over the age of 50 or smoke or drink alcohol.
(The writer is a senior consultant gastroenterologist at KIMS Hospital. The views expressed are his own).
