Mirror Bureau
27 October 2010

An unhealthy lifestyle takes a toll on your liver in more ways than one. Here’s the know–how on the latest addition to the lifestyle disorder list – Nonalcoholic Fatty Liver Disease
No talk about heart ailments, obesity, diabetes etc is complete without bringing in faulty lifestyles and wrong eating patterns as the prime culprits. Of late, this rather long and inglorious list has one more company – Non–alcoholic Fatty Liver Disease (NAFLD) – a condition marked by excess fat deposition in the liver in an individual who does not consume significant amounts of alcohol.

» So Why Worry
Like other lifestyle disorders, the numbers of NAFLD too are showing an upward curve, especially in urban areas. Data available with the national taskforce on NAFLD (part the Indian Association for the Study of Liver), show that the prevalence in India is almost at par with the West, about 20 per cent. And that amounts to a staggering 200 million people with fatty liver. Also, NAFLD in India affects males more frequently here than females (2:1). It usually manifests after 40 years, but can occur even earlier, for example, in those who are obese when young.
The taskforce is now forming guidelines, based on a multi–centric study for its management and treatment.

» How Does It Occur?
Our normal liver has minimal amount of fat. But when more than five per cent of the liver weight is due to fat, it is called ‘fatty liver’. The main reason why excess fat gets deposited in the liver is weak metabolism coupled with unhealthy diet. In fact, doctors say that people most predisposed to NAFLD are the ones who have, the ‘metabolic syndrome’ – individuals suffering from obesity, diabetes, hypertension, hyperlipidemia and hyperuricemia.

The presence of fat alone is not that harmful, but if the liver reacts to the fat it gets inflamed leading to a condition called the non–alchoholic steatohepatitis (NASH). This is a stage when NAFLD progresses to scarring (fibrosis) over months and years, finally leading to cirrhosis and many complications. NASH is thus a more severe subgroup of NAFLD and can be very dangerous if not treated early.

» Nafld And BMI
As NAFLD is closely linked to obesity, it’s useful to know the BMI (Body Mass Index) before taking preventive measures. In India, the prevalence is high even in those with ‘normal’ BMI, as defined by WHO criteria, unlike the West where the obese are primarily affected.

» Calculating BMI
The BMI is derived by dividing a person's weight in kilograms by his/her height in meters squared (kg/m2). In adults, therefore, following are the specifications:

• Normal weight – BMI between 20 and 25.
• Overweight – Between 25 to 30
• Obesity – 30 to 35
• Significant Obesity – 35 to 40
• Morbid Obesity – 40 to 45

The cut–off BMI levels for NAFLD risk in India may be as low as 22. That is, waist circumference of 90 cm in men and 80 cm in women, and waist hip ratio of 0.88 in men and 0.8 in women.

» Symptoms & Diagnosis
Interestingly, NAFLD and NASH are problems that usually have no symptoms! The diagnosis is made during a routine health check up (ultrasonography and biochemical liver profile) or when the patient undergoes these tests for some other reasons.

Which is why, it is estimated that the condition is more widespread than what figures indicate. Generally, those who are obese and are predisposed to the afore–mentioned "metabolic syndrome” will, in all probablity, have a fatty liver problem as well. Also, there is an entity loosely called ‘lean NASH’ where the condition occurs even in lean individuals. Unfortunately, the exact mechanism of the latter is not known.

» THe Healing Touch
Treatment should be not just of the condition but the causes too. Treatment for control of obesity or diabetes is a part and parcel of holistic lifestyle management, but even medications such as the UDCA and anti–oxidants are prescribed to protect the liver.

But the best preventive measure you can take is the age–old, timetested norm of maintaining a healthy lifestyle and avoiding the associated lifestyle disorders. Patients who have NASH must especially be careful. The two most important aspects here would be:

• Abstain from alcohol completely.
• Get evaluated for other medical disorders that may inflame the liver (eg, Hepatitis B and C) before the diagnosis is confirmed. You may have to consult a gastroenterologist to get a full idea of the entity.

» Modify Your Life
Once diagnosed with NAFLD, here’s how to turn your life 360 degrees for improvement, if not reversal.

• Weight management: Get moving and start exercising. Only mental activity isn’t enough.
• Diet management comes next. Give up processed food. Stick to the normal Indian thali.
• Improper sleep and smoking can aggravate the condition. Hence, try and audit your stress levels.

(Inputs by Dr. Philip Abraham,
Consultant Gastroenterologist
& Dr Sivaramakrishnan, lifestyle
mngmt consultant,
Hinduja Hospital, Mumbai)