Today is World Liver Day, an event observed to spread awareness about liver-related diseases. Fatty Liver Disease is among the most common conditions that impact many people in India and worldwide. Speaking with the OnlyMyHealth team, Dr Krishanu Banik, Consultant- astroenterology, Fortis Hospital, Anandapur, Kolkata, says, “Recent study suggests Alcoholic Fatty Liver Disease (ALD) is responsible for around 50% of all chronic liver disease cases in India, while Non-Alcoholic Fatty Liver Disease (NAFLD) is estimated to affect up to 30% of the population….Continue reading…
By: Tenzin Chodon
Source: OnlyMyHealth
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Critics:
Fatty liver can develop into hepatic fibrosis, cirrhosis or liver cancer. For people affected by NAFLD, the 10-year survival rate was about 80%. The rate of progression of fibrosis is estimated to be one per 7 years in NASH and one per 14 years in NAFLD, with an increasing speed. There is a strong relationship between these pathologies and metabolic illnesses (diabetes type II, metabolic syndrome). These pathologies can also affect non-obese people, who are then at a higher risk.
Less than 10% of people with cirrhotic alcoholic FLD will develop hepatocellular carcinoma, the most common type of primary liver cancer in adults, but up to 45% people with NASH without cirrhosis can develop hepatocellular carcinoma. The condition is also associated with other diseases that influence fat metabolism. Fatty liver (FL) is commonly associated with metabolic syndrome (diabetes, hypertension, obesity, and dyslipidemia), but can also be due to any one of many causes:
- Alcohol
- Alcohol use disorder is one of the causes of fatty liver due to production of toxic metabolites like aldehydes during metabolism of alcohol in the liver. This phenomenon most commonly occurs with chronic alcohol use disorder.
- Metabolic
- abetalipoproteinemia, glycogen storage diseases, Weber–Christian disease, acute fatty liver of pregnancy, lipodystrophy
- Nutritional
- obesity, malnutrition, total parenteral nutrition, severe weight loss, refeeding syndrome, jejunoileal bypass, gastric bypass, jejunal diverticulosis with bacterial overgrowth
- Drugs and toxins
- amiodarone, methotrexate, diltiazem, expired tetracycline, highly active antiretroviraltherapy, glucocorticoids, tamoxifen,environmental hepatotoxins (e.g., phosphorus, mushroom poisoning)
- Other
- celiac disease, inflammatory bowel disease, HIV, hepatitis C (especially genotype 3), and alpha 1-antitrypsin deficiency
Decreasing caloric intake by at least 30% or by approximately 750–1,000 kcal/day results in improvement in hepatic steatosis. For people with NAFLD or NASH, weight loss via a combination of diet and exercise was shown to improve or resolve the disease. In more serious cases, medications that decrease insulin resistance, hyperlipidemia, and those that induce weight loss such as bariatric surgery as well as vitamin E have been shown to improve or resolve liver function.
Bariatric surgery, while not recommended in 2017 as a treatment for FLD alone, has been shown to revert FLD, NAFLD, NASH and advanced steatohepatitis in over 90% of people who have undergone this surgery for the treatment of obesity. In the case of long-term total-parenteral-nutrition-induced fatty liver disease, choline has been shown to alleviate symptoms.This may be due to a deficiency in the methionine cycle.
NAFLD affects about 30% of people in Western countries and 10% of people in Asia. In the United States, rates are around 35% with about 7% having the severe form NASH. NAFLD affects about 10% of children in the United States. Recently the term Metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed to replace NAFLD. MAFLD is a more inclusionary diagnostic name as it is based on the detection of fatty liver by histology (biopsy), medical imaging or blood biomarkers but should be accompanied by either overweight/obesity, type 2 diabetes mellitus, or metabolic dysregulation.
The new definition no longer excludes alcohol consumption or coexistence of other liver diseases such as viral hepatitis. Using this more inclusive definition, the global prevalence of MAFLD is an astonishingly high 50.7%. Indeed, also using the old NAFLD definition, the disease is observed in up to 80% of obese people, 35% of whom progress to NASH, and in up to 20% of normal weight people, despite no evidence of excessive alcohol consumption. FLD is the most common cause of abnormal liver function tests in the United States.
Fatty liver is more prevalent in Hispanic people than white, with black people having the lowest prevalence. In the study Children of the 90s, 2.5% born in 1991 and 1992 were found by ultrasound at the age of 18 to have non-alcoholic fatty liver disease; five years later transient elastography found over 20% to have the fatty deposits on the liver, indicating non-alcoholic fatty liver disease; half of those were classified as severe. The scans also found that 2.4% had a degree of liver fibrosis, which can lead to cirrhosis.
After the lockdown of the COVID-19 pandemic, a study demonstrated that 48% of patients with liver steatosis gained weight, while 16% had a worsened steatosis grade. Weight gain was associated with poor adherence to the suggested diet, reduced levels of physical activity, and increased prevalence of homozygosity for the PNPLA3 rs738409 single nucleotide polymorphism. PNPLA3 rs738409 is already a known risk factor for NAFLD.
Fatty liver disease can occur in pets such as reptiles (particularly turtles) and birds as well as mammals like cats and dogs. The most common cause is overnutrition. A distinct sign in birds is a misshapen beak. Fatty livers can be induced via gavage in geese or ducks to produce foie gras. Fatty liver can also be induced in ruminants such as sheep by a high-caloric diet.
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