World Liver Day 2018: Emerging liver health crisis in Kerala, interaction between aberrant lifestyle and ‘bad’ genetics

World Liver Day is celebrated on April 19 to raise awareness about liver health and emerging liver diseases. According to the World Health Organization (WHO), liver disease is the 10th most common cause of death in India. The liver is the second largest organ in the body, which takes part in a multitude of functions. Most people think of it as a digestive organ, but in reality, the liver engages in immune mechanisms to thwart infections, filters and eliminates toxins in the food and water we drink, while playing a role active in the management of sugar, protein and cholesterol in the body. All the drugs that we take for various diseases after their function is completed are eliminated by the liver without causing their accumulation in the body.

Twenty years ago, Kerala’s state of health was almost comparable to that of developed economies. The state has succeeded in increasing life expectancy and reducing health indices such as infant and maternal mortality. Historically, public food distribution, state funded healthcare system in Kerala, high literacy rate especially among women have played a major role in improving the health scenario. Kerala’s ‘health model’ was once called ‘good health based on social justice and equity’. Although Kerala has long been known for its spectacular health feats and boasts of social development indicators on par with developed countries, an alarming rise in lifestyle disorders is pushing the state into crisis. sanitary. Growing wealth, lifestyle changes, junk food habits, obesity and the rising incidence of diabetes have all contributed to varying degrees to the health crisis. The non-resident Keralites, who played a pivotal role in the economic development of the state, indirectly contributed to the lifestyle changes mentioned above.

Read the story in Malayalam here.

Sedentary lifestyles, overeating habits not commensurate with one’s level of physical exercise, coupled with heavy alcohol consumption are the “trio problem” in the state, resulting in metabolic imbalance of caloric intake per food and its depletion through exercise, diabetes and, ultimately, various organ damage. The brunt of attacks due to these aberrant lifestyles is borne by the liver. Although it doesn’t get the same attention as organs such as the heart or the brain among the public, every bit of the unassuming liver is nonetheless crucial to life. In addition to over 500 vital functions – including filtering, cleansing, manufacturing and digesting – the liver has an incredible ability to regenerate and return to its original size, even after removal of up to 75% of the organ. Nevertheless, unhealthy lifestyles have pushed the livers of millions of people to the limit, leading to what experts are calling a SILENT EPIDEMIC of liver disease; a majority of this is due to fatty liver disease.

What is fatty liver disease?

A staggering 25% of the world’s population suffers from non-alcoholic fatty liver disease (NAFLD), a disease in which fat makes up more than 5% of the liver. Fatty liver disease can occur frequently with excessive alcohol consumption. Those who do not consume alcohol can develop fatty liver disease in the context of a sedentary lifestyle, unhealthy eating habits, a condition called non-alcoholic fatty liver disease (NAFLD). As mentioned earlier, when you eat more than the level of physical exercise you are doing, the excess
the calories that are not burned turn into fat and are deposited in the liver.

Over time – years or decades, in some cases – NAFLD progresses to a more serious condition called “fatty swelling” or non-alcoholic steatohepatitis (NASH), where the liver becomes inflamed and scarred, and eventually the structure and liver function are disturbed. Without treatment, the disease worsens into cirrhosis of the liver, an advanced stage disease where a liver transplant is the only life-saving option for the patient.

NAFLD is not entirely lifestyle related. Genetics also seems to play a role. Specific genes like PNPLA3 have been identified which predisposes individuals to diabetes and fatty liver disease. Unfortunately, this “bad genetics” inducing diabetes and fatty liver disease is more common in the Asian population than in the Western world. Until now, these bad genetics did not appear due to poverty and the agrarian economy in Asia, where physical exercise was an integral part of the common man’s lifestyle. With Asian economies changing, physical inactivity, overeating, and alcoholism have helped unmask the bad genetics that induce fatty liver disease. What appears to be alcoholic liver disease could actually be a combination of genetically linked NAFLD and alcohol-induced liver damage – alcoholic and non-alcoholic fatty liver disease with its liver scarring, liver failure and liver cancer risk is the growing epidemic, especially in Kerala, where aberrant lifestyle changes have been absorbed at a rapid pace compared to the rest of India. The purchasing power of the state of Kerala has certainly increased, but this has led to unhealthy eating habits. Being a non-agrarian economy, with a craze for blue-collar employment and consumerism as well as NRK remittances strongly supporting the economy of the state, a deep mismatch between exercise and dietary intake has arisen. is produced.

The high levels of alcohol consumption in Kerala had attracted global media attention as the BBC reported on it and ranked Kerala at the top of alcohol consumption in 2010-12. There was a tangible drop in consumption between 2014 and 2016 due to the closure of a few major bars by the Kerala government, but lately there seems to be an upsurge again.

Most chronic liver diseases are silent killers

World Liver Day 2018: Most of the time in countries like India where screening programs are not active, cirrhosis of liver is detected at a stage when a patient needs liver transplant for to survive.

Liver disease is largely silent without causing any signs or symptoms in the patient. The damage that occurs to the liver tissue through fatty liver, fatty liver and scarring of the liver is silent until the very advanced stage where liver function declines. Most of the time, in countries like India where screening programs are not active, liver cirrhosis is detected at a stage where a patient needs liver transplant to survive. This underscores the need for screening to detect this silent epidemic and halt the progression to advanced stages of liver scarring and liver cancer.

Once the silent process of liver scarring has set in, reversibility cannot be guaranteed. Needless to say, prevention is the way to go. At the very least, early detection of silent liver disease and treatment before permanent damage sets in should be aimed for.

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In Kerala, it is not uncommon to find young people in their thirties who develop cirrhosis of the liver. Alcoholism, which begins in campuses affected by genetically linked lifestyle liver diseases, namely NAFLD, is likely the reason for this alarming phenomenon. As a clinician engaged in targeted liver care for a decade, my youngest cirrhotic patient was 28 years old and had a family history of diabetes, high cholesterol and, on top of that, alcoholism – which started in high school. Raising awareness in the younger generation, right from school days, about overeating, lack of exercise, and alcohol abuse is the way forward to curb this liver health crisis.

Although other causes of liver diseases such as long-standing viral hepatitis B and C are less common in Kerala as compared to fatty liver disease, it is advisable to undergo screening and early treatment before the disease develops. permanent scarring of the liver does not set in. Hepatitis B vaccination is a unique intervention that prevents liver cirrhosis and liver cancer.

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