Context: International Fatty Liver Day (13th June) emphasises "Act Now, Screen Today," underscoring the urgent need for awareness and action against non-alcoholic fatty liver disease (NAFLD).
About Fatty liver disease epidemic:
- Liver diseases were predominantly associated with excessive alcohol use. However, in recent years, there is an emergence of a silently growing threat to liver health — non-alcoholic fatty liver disease.
- Risks: Fatty liver is closely linked to metabolic health, cardiac health, and a risk for developing cancers. This disorder has now been appropriately classified as ‘Metabolic dysfunction-associated steatotic liver disease’ (MASLD).
- MASH (Metabolic dysfunction-associated steatohepatitis), a progressive form that causes liver inflammation and scarring. It is expected to become the most common cause of chronic liver disease and the leading indication for liver transplantation.
- Consuming excessive carbohydrates, especially refined carbs and sugars, worsens these conditions by causing metabolic problems.
- When the body has too much glucose, it increases insulin production to help cells absorb the glucose. However, constantly eating too many carbs causes persistently high insulin levels, leading to insulin resistance, where cells become less responsive to insulin.
- Insulin resistance disrupts normal metabolism and promotes the conversion of excess glucose into fatty acids, which are then stored in the liver.
- The liver cells fill up with fat, leading to fatty liver. Over time, this continuous damage affects the liver’s ability to function properly, progressing from simple fatty liver to more severe conditions such as steatohepatitis and cirrhosis, which are hallmarks of MASLD, and may require a liver transplant.
- Symptoms: Despite the growing burden, the disease often goes undetected as there is usually no warning or symptoms in the early stages. Diagnosis is usually made at an advanced stage, often when significant liver damage has already occurred.
- Prevalence: The global prevalence of MASLD is estimated at 25-30%. In 2022, a meta-analysis revealed that in India, the pooled prevalence of fatty liver was 38.6% among adults, while among obese children, it was around 36%.
Techniques for Diagnosis:
- Physical examination includes height, weight, body mass index (BMI), abdominal girth, and waist-to-hip ratio to assess visceral fat which is an important marker of metabolic health.
- Blood tests to cover cardio-metabolic risk factors include a blood count, sugar profile, blood lipid profile, liver function tests, and kidney tests.
- Ultrasound of the abdomen is an important test to screen for liver disease and an important first step to diagnose fatty liver.
- Advanced liver tests will include liver fibrosis assessment to look for liver scarring, most accurately done by using newer technologies such as vibration-controlled transient elastography. This is a simple non-invasive tool and it measures liver stiffness to assess early stages of liver fibrosis.