Fatty liver disease is the accumulation of excess fat in the liver. It is well known that excessive alcohol consumption leads to an enlarged liver and this can lead to serious liver damage if an individual continues to drink alcohol in excess. But in the last 30 years, doctors have noted that there are a large number of patients who drink very little or no alcohol, but continue to have excess fat in the liver. This condition is known as non-alcoholic fatty liver disease (NAFLD). It has also been found that this form of fatty liver disease can cause further swelling (inflammation), liver scarring (cirrhosis), liver cancer and liver failure.
Fatty liver is an extremely common disease and it is estimated that it affects up to 5 -20 per cent of Indians. NAFLD can affect men, women, and children of all ages. It is most common in people who are overweight. The risk is further increased if an individual has diabetes, high cholesterol or high blood pressure. Consumption of a diet rich in fat, calories and fructose is also associated with a fatty liver. With one in six persons overweight, 15 per cent of Indian children overweight, there is also an increase in the occurrence of diabetes.
Fatty liver generally progresses through the following stages:
Simple fatty liver
Fatty liver with inflammation. Also known as non-alcoholic steatohepatitis or NASH
Fatty liver with liver hardening and liver scarring (known as liver cirrhosis)
It is estimated that the simple fatty liver may affect 5-20 per cent of Indians. But the good news is that most individuals almost never progress to severe liver damage. However, if the person develops liver cirrhosis, there is a high risk of liver failure, liver cancer and death.
Symptoms: Most people with fatty liver will not show any obvious signs. Some may experience a dull pain on the right side of the belly due to enlargement of the liver. Other symptoms are general fatigue, nausea and loss of appetite. Once cirrhosis develops and liver failure sets in, there may be a yellowness of the eyes, accumulation of fluid in the body (edema), vomiting of blood and jaundice.
Diagnosis: Fatty liver is usually noticed during routine checkups when a doctor spots an enlarged liver through a scan. Blood tests of the liver may be abnormal or an ultrasound scan may show fat in the liver. It is also popularly called the “silent disease”. There are no symptoms until the condition progresses to liver cirrhosis or failure. So never miss your routine check ups if you are a regular consumer of alcohol, are overweight, have diabetes and high level of cholesterol.
Treatment: There is no medication to treat a fatty liver. Early fatty liver is usually easily reversed through dietary changes, weight loss, exercise and control of risk factors such as diabetes. Obese patients may benefit from weight loss (bariatric) surgery.
Lose weight if you are overweight, but avoid rapid weight loss.
Exercise at least 30 minutes per day.
Reduce the amount of fat in your diet.
Avoid a carbohydrate-rich diet (potatoes, white bread, white rice). These get absorbed quickly by the intestines and get converted to fat in the liver. Food items that get absorbed slowly (such as unprocessed fruit, nuts, pulses and grains, apples and oranges) are beneficial.
Be cautious of eating too many fruits, juices and carbonated drinks rich in fructose.
Antioxidants such as Silymarin, Vitamins C and E may have some benefit.
Never miss your annual health checkups.
If you have diabetes and hypertension, treat it effectively.
Even if you are a light alcohol drinker, it is ideal to stop alcohol consumption completely.
The author is a consultant in Liver Diseases and Transplantation at BGS Global Hospitals, Bangalore.
Mangalore: Liver transplant completely safe, ensures good quality of life: Experts
Mangalore, May 23, 2013: The city branch of Indian Medical Association (IMA) and Institute for Liver, Pancreatic Diseases & Transplantation, BGS Global Hospital, Bangalore jointly conducted a Continuing Medical Education (CME) programme on ‘Liver Transplantation’ recently at Dr A V Rao Conference Hall, IMA House, Attavar, Mangalore.
A team of liver transplantation experts from BGS Global Hospital led by Dr Kaiser Raja, head of the department of Hepatology and Gastroenterology and comprising Dr Mathew Jacob, senior consultant, Hepatobiliary and Transplantation Surgery and Dr V. Arun, senior consultant, Pain Medicine were the speakers for the Scientific Programme.
After the rendering of the IMA prayer, the IMA president Dr M Manjunath Shenoy welcomed the gathering. Dr Nithish M Bhandary, IMA secretary gave a report of the month’s activities.
The scientific programme consisted of three guest lectures followed by question/answer forum.
The first speaker Dr Kaiser Raja addressed the doctors regarding ‘Optimal Timing and Selection of Candidates for Liver Transplantation’. Indentifying Alcoholic Liver Disease, Chronic Hepatitis B (HBV), Chronic Hepatitis C (HCV) and Fatty Liver as the most common culprits for liver damage, he enlightened the doctors about various facts regarding liver transplantation. “In India, alcoholics are the most common patients for liver transplantation accounting for about 42% of the transplants. The other patients are HBV (9%), HCV (5%), and Liver Cancer (10%),” he said,
The second speaker Dr V Arun spoke on ‘Anesthetic Challenges in Liver Transplantation’. “Liver disease is the ninth most common reason for death in India,” he said, “The liver is a unique organ of the body as it is the only body part which can regenerate even if 70% of its volume is removed and just 30% is left.” He introduced the concept of Integrated Liver Care, whereby a specialized multidisciplinary team of doctors and professionals drawn from various streams provide the comprehensive treatment under one roof. Touching upon critical care requirements, he also explained the concept of specialized Liver ICU. “Mortality was 20% in the 70’s, now it is less than 3%”, he said.
The third speaker Dr Mathew Jacob spoke on ‘Liver Transplantation and HpB Surgery – Towards Integrated Care’. “Today liver transplant is an established mode of treatment. It is completely safe and is a good way to survive with good quality of life,” he said, “The patient can expect to live a normal life within six months to one year of the transplant.”
He explained that liver transplant can be performed from two sources: from cadaveric donors and live donors. In cadaveric donors, the liver is harvested once it is ascertained that the person is brain dead and the legal, medical and ethical formalities are completed. “Cadaveric donors are the ideal donors for liver transplant. In the West, almost 90-95% of the transplants are from this source. In India, due to the scarcity of cadaveric donors, we are dependent on live donors to the extent of 80%. This situation should change gradually as there are many agencies and NGOs promoting liver donation in a big way,” he said.
Later answering various questions from the doctors, the panel of speakers explained that Liver Transplantation calls for integrated care and at present there are only 6 or 7 centres in India which do over 50 liver transplants per year.
They urged that organ donation should be encouraged and promoted so that more transplants can be performed from cadaveric donors. This can be achieved with greater awareness. It is important that those who want to sign up as cadaveric donors should discuss the matter with their families as they will be the ones who have to take the call, they said.
It was also clarified that, unlike in kidney transplantation, transplant rejection is not a big issue in liver transplantation. “About 10% of the patients may require treatment and the good news is that it is completely treatable.”