Liver disease is reversible with lifestyle changes — PCP


By Patricia B. Mirasol, Journalist

TO AVOID liver cancer, people who are overweight, diabetic, or have high blood pressure should strive to lose enough pounds to stay within the healthy range, get vaccinated against hepatitis B and drink alcohol in moderation (or avoid it completely).

These lifestyle changes can help prevent fatty liver disease, “the fastest growing cause” of liver cancer (also known as hepatocellular carcinoma or HCC) in the world. according to several studies.

“There are no safe limits for alcohol, to reiterate our position,” said Dr Diana Alcantara-Payawal, president of the Philippine College of Physicians and regional representative of the Global Liver Institute, meaning the the safest number of drinks is zero.

“When you gain weight in the middle…there’s also more susceptibility to MAFLD, or metabolism-associated fatty liver disease,” she said during a June 16 webinar by the Hepatological Society of the Philippines.

MAFLD, formerly known as non-alcoholic fatty liver diseaseis a condition characterized by an accumulation of fat in the liver.

Fatty liver disease refers to a range of liver disorders not caused by alcohol consumption, autoimmune diseases, drug use or viruses. At least 18 million Filipinos suffer from it or are at risk of suffering from it.

Even those who are of normal weight – or a body mass index less than or equal to 23 kg/m3 in Asians – are at risk for the disease if at least two other factors are present. These include: having a waist circumference greater than or equal to 90 centimeters for Asian men, or greater than or equal to 80 centimeters for Asian women, as well as high blood pressure greater than or equal to 130/85 mmHg.

A 2018 study co-authored by Dr Payawal on the 2003-2018 etiology of HCC in the Philippines found that liver cancer due to hepatitis B has been on a downward trend over the years, thanks to hepatitis B vaccination. However, non-alcoholic and alcoholic fatty liver disease is on the rise.

“We can see that this is an upward trend in the etiology of liver cancer, from a communicable disease due to hepatitis B to a non-communicable disease,” said the Dr Payawal.

This growing MAFLD trend also extends to Asia-Pacific, including countries like Taiwan and Malaysia, “due to the upward trend rapid urbanization [that has led to] less exercise,” she added.

While a normal liver contains less than 5% liver fat, an accumulation can progress from steatosis (fatty liver without inflammation), steatohepatitis (fatty liver with inflammation), cirrhosis (scarring of the liver) to HCC ( the most common primary liver cancer that occurs in people with chronic liver disease).

According to Dr. Payawal, an absence of cirrhosis is reported in 30-50% of Asians with HCC associated with MAFLD. Among this group, she added, steatosis can transform directly into HCC or vice versa provided the patient changes his lifestyle.

“The caveat is that there is reversibility at all stages of the disease,” she said. “There is light at the end of the tunnel if you are diagnosed… There is reversibility up to cirrhosis. It’s not too late to institute a lifestyle intervention because that’s the key to all of this,” she said.

The liver regulates most chemical levels in the blood and excretes a product called bile, which helps flush waste products from the organ.

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