As per a recent study conducted by the University of Hyderabad, about 84 per cent IT employees in India have fatty liver disease while around 71 per cent are obese, and about 34 per cent of them had metabolic syndrome. The study attributed this build up of excess fat in the liver to sitting for prolonged hours at the work desk, stress, inadequate sleep, unearthly shift timings. THE WEEK speaks to Dr Aabha Nagral, Director Gastroenterology, Chief Hepatologist and Liver Transplant Physician on the challenges and ways of addressing the fatty liver issue.
What as per you constitutes a fatty liver?
Any patient with more than 5 per cent of liver weight as fat constitutes a fatty liver. Majority of patients with fatty liver have no symptoms. Often, the fatty liver is detected on an ultrasound of the abdomen done for any reason or through findings of abnormal liver function tests or on a test called fibroscan which is like a specialised ultrasound of the liver and gives information on the amount of fat and scarring in the liver. The patient may have a dull ache in the right upper abdomen under the rib cage which is site of the liver.
In your own practice, have you observed a radical increase in the number of cases related to fatty liver disease?
Yes, I have definitely observed a dramatic increase in the number of cases of fatty liver. Though increased health check ups lead to the diagnosis of fatty liver, there seems to be a real increase in the number of patients because of change in lifestyle and food habits. There is also an increased awareness amongst the medical professionals and the general population about the fact that fatty liver should not be ignored.
When does a fatty liver progress to disease? On a scale, what are the initial and severe forms?
Fat in the liver alone is not harmful (simple fatty liver) but with continuing fat deposition and inappropriate life style and a genetic tendency, fatty liver gets converted in to a disease called steatohepatitis (steatosis = fat, hepatitis = inflammation) which means an inflammed liver due to fat deposition. This can progress to cirrhosis or scarring of the liver with development of a cancer of the liver called hepatocellular carcinoma. These patients in the end stage often need liver transplantation.
What is the age group that is most affected and what are the symptoms you've noticed?
Right from adolescents to older individuals can get affected by fatty liver. The problem is that often there are no symptoms and patient may directly present with cirrhosis or liver cancer. Some patients may present with a dull pain under the lower right rib cage where the liver is situated. If there is development of cirrhosis - typically in a patient who has had a fatty liver for many years, there may be weight loss with low of muscle mass (sarcopenia) over upper and lower limbs, swelling of feet, a large belly (ascites), jaundice or vomiting blood or passing a jet black loose stool. However, in early cirrhosis there may be no symptoms and the blood tests for liver function may also be normal. Patients of cirrhosis are advised to get an ultrasound of the abdomen and a blood test called AFP (tumor marker for liver cancer) every 6 months as they have a risk of developing liver cancer.
As a nation, are we genetically prone towards developing a fatty liver?
Indians tend to have a proportionately higher waistline. This is directly proportional to the amount of fat in the liver and other vital organs. We can see the disease running across generations of families with multiple members affected with fatty liver and its complications such as cirrhosis or liver cancer.