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Non – Alcoholic Fatty Liver Disease(NAFLD)

A growing public health problem

It is an umbrella term for a range of liver conditions affecting people, who drink little or no alcohol.  As the name implies, the main characteristics of NAFLD is too much fat stored in liver cells.  The disorder has a wide spectrum, ranging from symptomatic steatosis to steatohepatitis (potentially serious form marked by liver inflammation, which leads to scarring and irreversible liver damage) fibrosis and cirrhosis. 

Recent findings suggest that contrary to current dogma, simple steatosis can progress to Non-Alcoholic Steatohepatitis (NASH) and clinically significant fibrosis.  Therefore, the majority of non-alcoholic fatty liver disease patients are at risk of progressive liver disease in the long-term.  In western world, now it is the second leading etiology of chronic liver disease among adults awaiting liver transplantation. 

What are the risk factors?

Common risk factors are Obesity, Type 2 Diabetes mellitus , Dyslipidaemia , Metabolic syndrome and Polycystic ovarian syndrome. Other conditions like hypothyroidism, hypopituitarism, hypogonadism, etc.

As per recent evidences, non-alcoholic fatty liver disease is now considered as a multisystem disease affecting several extrahepatic organs. i.e., there is increased risk of type 2 diabetes mellitus, cardiovascular, and chronic kidney disease.  It is also linked to sleep apnea, adenomatosis, polyps of the colon, colorectal cancer, osteoporosis, PCOD, psoriasis, and various endocrinopathies. So, NAFLD has become a growing public health problem.

 Discussing about what we can do to prevent the development or progression of NAFLD

The single most important aspect is lifestyle modification, which includes diet modification, exercise, and weight loss.  

Diet modification

  1. Follow a good dietary pattern such as the Mediterranean diet – a plant based diet, which is high antioxidants and anti-inflammatory.
  • Consume small amounts of meat especially red meat.
  1. Avoid highly processed food, which contains added fructose.
  • Avoid sweetened beverages.
  1. Increased consumption of Omega 3 polyunsaturated fatty acids and monounsaturated fattyacids.
  • Consume fish two to three times per week especially oily fish such as salmon, sardines, jamfish, tuna, etc.
  • Use extra-virgin olive oil as the main added fat especially for dressing salads and
  • Consume nuts and seeds as snacks daily.
  1. Increased consumption of high fibre food.
  • Eat vegetables with all main meals, ensuring they compose the majority of the dish.
  • Choose the whole grain varieties of breads and cereals.
  • Have legumes two to three times per week in place of meat.
  • Have fresh fruit daily.
  1. Limit consumption of highly processed food.
  • Avoid food that is highly refined.
  • Avoid food that contains large amount of added sugars.
  • This may include fast food, commercial bakery goods, and sweets.

 Exercise

People with NAFLD engage in less physical activity than their healthy counterparts and higher levels of habitual physical activity.  Moderate intensity training, high intensity training, and resistant/aerobic exercise have shown improvement.  Therefore, all those with risk factors are advised to increase physical activity. 

  1. One approach is to recommend 30 minutes of moderate exercise 5 times weekly.
  2. Another approach is to try to increase daily step count to more than 10,000 steps per day.

Weight loss

Ideally, patient should be encouraged to lose more than 10 percentage of body weight and maintain the weight loss or bring their waist circumference or BMI into their ethnicity specific normal range.  

As WHO and the Governments worldwide are trying to provide universal health coverage for all, which ensures quality healthcare to people when and where they need them without suffering financial hardships, on World Health Day I would suggest all fellow citizens to have a healthy lifestyle, so that we can prevent lifestyle diseases to an extent.