Lifestyle has to be blamed, according to Dr Ajay Duseja, Professor and Head, Department of Hepatology, PGIMER, for non-alcoholic fatty liver disease or NAFLD.
Fatty liver disease or Steatotic liver disease (SLD) is a major cause of chronic liver disease globally and in India.
“We did an analysis here at PGIMER, wherein we screened about 1,000 so-called healthy blood donors, doing an ultrasound, and were surprised that 53 per cent had fatty liver.
More importantly, NAFLD in patients with metabolic co-morbidities like obesity, Type 2 diabetes mellitus or hypertension have a higher risk of developing severe liver disease.
“Data shows that if detected early, fatty liver is reversible and all are not the same, some are benign.
Lifestyle has to be blamed, according to Dr Ajay Duseja, Professor and Head, Department of Hepatology, PGIMER, for non-alcoholic fatty liver disease or NAFLD. The disease is caused due to the excessive accumulation of fat in the liver in the absence of other causes of liver diseases including significant alcohol intake. This fat can lead to inflammation (non-alcoholic steatohepatitis or NASH) and scarring (fibrosis) of the liver which may progress to cirrhosis and liver carcinoma in the long run.
Fatty liver disease or Steatotic liver disease (SLD) is a major cause of chronic liver disease globally and in India. Globally, one in every three individuals have underlying NAFLD. In India, the burden of NAFLD is humongous with an estimated prevalence of 38 per cent. The prevalence is particularly high in north India and in Chandigarh with an estimate that almost 1 in 2 persons has underlying NAFLD.
“We did an analysis here at PGIMER, wherein we screened about 1,000 so-called healthy blood donors, doing an ultrasound, and were surprised that 53 per cent had fatty liver. It is important to create awareness of NAFLD, which may be a silent killer as it often remains asymptomatic in the early stages,” said Duseja.
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NAFLD is primarily a lifestyle disease with insulin resistance being the central driver. At the most basic level NAFLD may be considered a state of energy excess where the dietary calorie intake exceeds the calories that are burnt out during physical exertion resulting in fat accumulation in the liver.
“Given the central role of insulin resistance, it is not surprising that NAFLD is closely associated with other chronic metabolic diseases like obesity, type 2 diabetes mellitus, hypertension and dyslipidemia. On the one hand, patients with obesity and diabetes are more likely to have NAFLD, while on the other hand patients with NAFLD are more likely to be diabetic or obese. More importantly, NAFLD in patients with metabolic co-morbidities like obesity, Type 2 diabetes mellitus or hypertension have a higher risk of developing severe liver disease. Due to this intrinsic relationship with these metabolic co-morbidities, the name of NAFLD has recently been changed to metabolic dysfunction associated steatotic liver disease or MASLD,” the hepatology professor said.
He further suggested that lifestyle interventions are the mainstay for both the prevention and management of NAFLD/MASLD. “This entails both dietary calorie restriction, and exercise which should go hand in hand. We eat a calorie-rich diet, high in fats, sugar and carbs. Portion control, and a balanced diet, with optimum expending of calories is vital. We must burn more calories than we take in. Don’t miss a meal or snack on junk food and don’t eat late at night,” Duseja added.
The incidence increases in postmenopausal women, as estrogen levels decrease, and NAFLD is also increasing in children, according to the PGIMER doctor. “Data shows that if detected early, fatty liver is reversible and all are not the same, some are benign. A simple liver function test, platelet count can give us clear indication of the disease, and risk factors are BP, obesity, and diabetes,” Duseja said.
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Drugs, he added, have a limited role in only a selected group of patients and the management of NAFLD/MASLD should be holistic and other metabolic disorders including diabetes, hypertension and dyslipidemia should be adequately controlled. “All fatty liver (MASLD) are not same and rather than ignoring it, full attention should be given for evaluation in defining the exact stage of liver disease in these patients which could vary from just fat in the liver to associated inflammation (swelling) or fibrosis (scarring),” summed up Duseja.
