Fatty Liver becoming Recipe for Fatal End Stage

Child is the Father of Liver Transplant in India

Indian Government wakes up to alarming reality just in time

The alacrity with which Union government has taken measures to stem rot in livers of people speaks a volume about the enormity of the problem. Fatty liver is increasingly becoming recipe for the fatal end stage of the body organ most vital for maintaining overall human health. Even children not in small number are becoming vulnerable to this escalating disorder. The silent epidemic remaining asymptomatic for ages is taking a vast swathe of Indian population in its vice like grip.

New Delhi:  Child is the Father of Liver Transplant in India – The saying may sound extremely alarmist but given the escalating fatty liver conditions in children, it is not much wide of the mark. The cruel fact is if obese children with fatty liver are left untreated, they might become candidates for Transplant when they become adult.

A moment on the lips, a lifetime on the hips – for sure, it is a body shaming rhetoric but it is high time in India on the occasion of World Liver Day ( April 19) to remember this adage seriously because fatty liver disease is assuming alarming proportions here. Indian livers, even those of teetotallers, are on a perilous road to abnormalities like cirrhosis and cancer, thanks to faulty life style and food habits. Alcohol is not the only villain of the piece in causing this condition, your faulty foods and life style too is.  Fatty liver is on the verge of being the leading cause of liver transplantation globally.

The alacrity with which Union government has taken measures to stem rot in livers of people speaks a volume about the enormity of the problem. Fatty liver is increasingly becoming recipe for the fatal end stage of the body organ most vital for maintaining overall human health. Even children not in small number are becoming vulnerable to this escalating disorder. The silent epidemic remaining asymptomatic for ages is taking a vast swathe of Indian population in its vice like grip.

It is given that calories are never a good company. The concern is, in India, people are having live –in relationship with fat! Given the alarming situation of fatty liver disease, thinking before taking the plunge into calories laden food and snacks is a life saving idea. Free liver- a person who follows a way of life that feely indulges the appetites- is doomed to be in chain of a life threatening end stage of the vital organ.

Though it is a global problem, thankfully Indian government has become the first country to wake up to the reality of the escalating liver situation. Indian government has swiftly moved ahead to integrate NAFLD (Non – Alcoholic Fatty Liver Disease) with NPCDCS (National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Strokes. While launching the operational guidelines for this integration last February, Dr Harshvardhan, Union Minister of Health and Family Welfare, presented this disease as a serious situation for India. Dr Harsh vardhan said, ‘NAFLD, the abnormal accumulation of fat in the liver in the absence of secondary causes of fatty liver such as harmful alcohol use, viral hepatitis or medication is a serious health concern as it encompasses a spectrum of liver abnormalities from a simple non alcoholic fatty liver (NAFL, simple fatty liver disease) to more advanced ones like non –alcoholic steatohepatitis, cirrhosis and even liver cancer.’

Uday India talked to a number of liver experts about the enormity of fatty liver problems in India and all of them praised the central government for being so proactive in tackling this burgeoning menace. Renowned liver expert and Director, Institute of Liver and Billiary Sciences (ILBS), Delhi, Dr S K Sarin  has been warning the country of the burden of liver diseases for ages. In fact, he set up this apex liver treatment facility keeping in mind the growing need for tackling this menace.

Dr Neelam Mohan, Director- Paediatric Gasteroenterology and Hepatology (India’s leading Paediatric Liver Transplant Specialist), will address World Congress in Vienna this year in June on fatty liver in Children. Talking to Uday India, Dr Mohan said the incidence of fatty liver in obese children in India is worrisome. It must be tackled forthwith to save them from becoming future candidates of liver transplant. Dr Mohan appreciated Dr Harshvardhan for taking timely steps to stem the escalating crisis.

Dr Anupam Sibal, Pediatric Gastroentero and Hepatology (Group Medical Director-Apollo Hospitals) is instrumental in setting up the most successful liver transplant program in India. Talking to Uday India, Dr Sibal said, ‘Fatty liver problems in India should be major Concern for health policy makers. PM Modi government at the centre is worthy of great praise for waking up to this menace. Obese children having fatty liver is also becoming a major burden of liver disease. It is indeed wake up time.’

Talking to Uday India, Dr Shailendra Lalwani, Head of the Department of Liver Transplant and Hepato-Pancreatic-Billiary Surgery in Manipal Hospital Delhi, said, ‘ Because of fatty liver, we will have early diabetes, early heart failure , early blood pressure et al. Fatty liver may be prelude to all sorts of non communicable diseases. It is going to be a major problem in India and the Union govt is right in taking up this in earnest. Time is not far away when fatty liver will become the number one leading cause of liver Transplant.’

Prof (Dr) Subhash Gupta , chairman, Centre for Liver and Billiary Sciences (Liver Transplant Surgeon), Max Healthcare, said, ‘ fatty liver is assuming very serious proportions. Intervention at policy level at this stage is a must. It is praiseworthy that the central govt is seized of the matter and has shown alacrity and urgency.’

Dr Pradeep Kumar Chowbey, Executive Vice Chairman of Max Healthcare and Chairman of Minimal Access, Metabolic and Bariatric Surgery in Max Healthcare, said, ‘bariatric surgery has emerged as a potent intervention to unburden the organ. We see liver becoming free of excess fat after surgery. Bariatric surgery is emerging as option in patients with morbid obesity and advanced fatty liver damage with progressively worsening insulin resistance.’

For the unversed, there are two types of fatty liver disease – NAFLD and AFLD. Fat can accumulate in the liver as part of metabolic processes and up to five per cent fat in liver substance is considered to be normal. But it has crossed limit and is more than 10 per cent and counting. Those who consume alcohol regularly invariably would deposit more fat in their livers (Alcoholic Fatty Liver Disease- AFLD). Those who do not drink, but engage in faulty lifestyles develop Non-Alcoholic Fatty Liver Disease (NAFLD).

Figures are intimidating. Over the last two decades, global burden of NASH has more than doubled and India has a large share in it. NAFLD is emerging as an important cause of liver disease in India. Multiple studies have underlined that situation is alarming. According to those studies, the prevalence of NAFLD is around nine per cent to 32 per cent of the general population in the country with a higher prevalence in those with overweight or obesity and those with diabetes or pre diabetes.  Researchers have found NAFLD in 40 per cent to 80 per cent of people who have type- 2 diabetes and in 30 per cent to 90 per cent of people who are obese. Studies also point to the fact people with NAFLD have a greater chance of developing cardiovascular disease.

Cardiovascular disease is the most common cause of death in NAFLD. Once the disease develops, there is no specific cure available, and health promotion and prevention aspects targeting weight reduction, healthy lifestyle, and control of aforementioned risk factors are the mainstays to disease progression and prevent the mortality and morbidity due to NAFLD.

NAFLD is an independent predictor of future risk of cardiovascular diseases, type 2 diabetes and other metabolic syndromes like hypertension, abdominal obesity, dyslipidaemia, glucose intolerance.

Kerala has reported not long ago a prevalence of fatty liver in 49 per cent and a big 60 per cent prevalence among obese school going children. Rural Haryana reports 30 per cent, 53 per cent in Chandigarh and 30 per cent in Odisha. Paediatric NAFLD in India is really an alarming situation. Affluent kids consume aerated sugary beverages and fast food. Junk food culture triggered by ubiquitous KFC, McDonald, etc is taking a heavy toll on liver health of our children by making them obese and inducing fatty liver disease.