Marking International NASH (Non-alcoholic steatohepatitis) Day 2022 doctors in India have claimed that non-alcoholic fatty liver disease (NAFLD) may be present at some stage of the disease in around forty percent of the population.
While the claim seems bold, NAFLD is thought to be present in around 25 to thirty percent of the global population. The Indian National Association for Study of the Liver (INASL)-NAFLD Taskforce and Indian Consortium on NAFLD (ICON-D) has launched an “Action plan for the prevention and control of non-alcoholic fatty liver disease in India” as a response to the issue.
Like many other noncommunicable diseases (NCDs) that are currently becoming ever more prevalent in India, a key component of the rise in cases is lifestyle. While alcoholism can contribute to alcoholic fatty liver disease, NAFLD is often caused by factors such as a sedentary lifestyle and obesity. Other issues, such as diabetes, hypertension and dyslipidemia also act as risk factors for liver disease.
As previously reported by Health Issues India, “India faces a number of issues. Its obesity burden has steadily risen in recent years. Alcohol consumption, similarly, has increased. And the country shoulders a substantial burden of hepatitis, with viral hepatitis affecting almost sixty million Indians and killing 1.5 lakh people in the country annually.”
These factors all combine to create a significant burden of liver disease, as well as create a situation where multiple risk factors may be found within an individual leading to a considerable risk of developing liver issues in the future.
As recently as 2017, predictions regarding the prevalence of liver disease in India were far less severe. Doctors at the time predicted that one in five Indians would be diagnosed with liver disease. For predictions to now place the percentage of Indians affected at close to forty percent is of dire concern.
Given the prevalence of the condition, it is important that it is diagnosed and treated early. In order to do so, knowledge of the symptoms is critical. There are more generalised symptoms that may occur early on in the disease progression, such as nausea, vomiting, decrease in appetite and persistent fatigue. Some symptoms are characteristic of liver disease, the most well known of which is jaundice, or a yellow tone to the skin and eyes.
Several kinds of liver conditions, ranging from alcoholic fatty liver disease, NAFLD, or viral hepatitis can cause these symptoms, as well as issues such as sudden weight loss, abdominal pain or dark urine and pale stool. Should these symptoms develop, medical attention should be sought immediately. Should symptoms be ignored, they can progress to a point where the damage to the liver becomes permanent, through conditions such as liver cirrhosis.
Liver cirrhosis is a hallmark symptom of many liver conditions. Defined as the buildup of scar tissue within the liver from prolonged periods of damage (hepatitis B and C or alcohol being common causes), it is a non-reversible condition which can severely impair the function of the liver. It is possible that if the scarring becomes extensive the liver will stop functioning altogether, causing liver failure.
Experts in India have suggested the use of education campaigns to teach the importance of a healthy lifestyle with the hopes of combating the rising cases of liver disease. Regular exercise, as well as healthy diets rich in foods such as fruit and vegetables can help to stave off the condition, and are also used as methods of disease management for those who have already been diagnosed.
Often patients will ignore early warning signs. As the disease typically has a slow progression, it may remain overlooked for some time. Such an approach is counterintuitive, as in its early stages liver disease is often able to be addressed simply through lifestyle change. If the disease is allowed to progress to later stages, issues such as liver cirrhosis result in permanent damage to the liver, necessitating pharmacological intervention. At the most extreme, a liver transplant is required – a major issue given India’s severe lack of available organ transplants.
Education is likely to be key to reducing the rate of liver disease. More must be done to dispel the belief that treatment can wait, and that the disease is not an urgent matter. The benefits of a healthy lifestyle must be highlighted, and will bring benefits to far more areas of healthcare than just alleviating the rate of liver disease.