Known as the second largest and the most complex organ in the human body, the liver is important as it performs an essential function in the body’s digestive system.
While metabolism of carbohydrates, proteins and fats is done by the liver, along with basic functions of excretion of waste substances and toxins from the body it also has other functions of excreting bilirubin, drugs, hormones, and cholesterol too.
According to The World Health Organisation, liver disease is the 10th most common cause of deaths in India and there are numerous kinds of liver diseases which can be life threatening.
Alcohol and Non Alcoholic Fatty Liver Disease (NAFLD) and Non Alcoholic Steato Hepatitis (NASH) are the two major diseases and causes for liver transplantation presently.
Consultant gastroenterologist, Healthway Hospital, Sanjay Altekar says: “Gone are the days when liver disease was only associated with the consumption of alcohol. Globally, there is an epidemic of fatty liver disease causing morbidity and mortality.”
Fatty liver (FL) is a common disorder that affects more than 70 million adults in India. FL is a life style disorder and is mainly seen in people who are overweight or obese, have diabetes, high blood pressure, or high triglycerides (blood fats), low ‘good’ HDL cholesterol, or lead a sedentary lifestyle. The prevalence is especially common in those who eat highly processed food.
“It is one of the most common forms of liver disease; with an estimated 30-40 per cent people in India having early forms of FL. FL can affect any age group. In fact, previously it was common in adults, but now we are seeing young children being affected by it due to increasing obesity in children and lack of physical activity,” says Altekar, before adding that it is a misconception that only obese are affected with FL disease. Even those who are slim can get the disease – which is a typical South Asian problem.
FL is a chronic yet silent disease, which means that most patients live with it for several years without experiencing any symptoms and are mostly unaware of their liver condition. However, it’s common to feel tired and some have a persistent pain in the upper right part of their abdomen.
“FL, if not attended to can progress to fibrosis (scarring), cirrhosis, and liver failure in about 15-20 per cent people. It also increases the risk of liver cancer. People with FL are also at an increased risk of developing heart attack, diabetes and stroke,” informs Altekar. However, it can be reversed if diagnosed early. Simple fatty liver may go away if the underlying cause is tackled.
Another consultant gastroenterologist, Healthway Hospital, Harish Peshwe tells us that Non Alcoholic Fatty Liver Disease (NAFLD) and Non Alcoholic Steato Hepatitis (NASH) are increasingly widespread across Goa too and slowly affecting the younger age group too.
“Significant numbers of young individuals in the age group of 18-30 years are found to be having elevated liver enzymes and varying grades of fatty liver without significant alcohol intake,” says Peshwe. Most cases are detected due to the compulsory blood and fitness tests requested for by shipping companies.
He states that significant dietary changes are seen in his practice in the age group of 18-30 years with consumption of fast foods, high calorie, and especially sugars, which could have a direct link for the increased prevalence of NAFLD (Fatty liver).
“Drug-induced liver injury (Herbal hepatotoxicity) due to various non-allopathic medications is seen in increasing amounts in our population coupled with cases of heavy metal (lead mainly) contamination,” he explains. These can cause liver damage and at times failure of the liver and death in individuals with pre-existing liver ailments.
Alcohol abuse (drinking alcohol in excessive quantities) on the other hand can cause alcoholic liver disease. When over drinking, the alcohol enters the blood stream. And this then affects the brain and heart.
Peshwe states that alcohol as always is a major cause for liver cirrhosis in Goa and continues to be so. “The easy and cheap availability of liquor even in remote places easily entices the youth and we see cases of severe liver disease in males as young as 18 years who need hospitalisation for jaundice and eventual liver transplants,” he says.
Liver diseases pose a significant burden, both financially and socially, within the family who are often in debt, battling costs of healthcare. “The cost of liver transplantation being high; not many are able to afford it and hence these patients require repeated admissions and they slowly but surely suffer financially,” he explains.