New liver disease tied to obesity......Dr sylvester Ikhisemojie

Dr. Sylvester Ikhisemojie

In the past 20 years or so, the prevalence of a new disease known as Non-alcoholic Fatty Liver Disease has become a major health challenge. It has shown an alarming rate of increase in adults and has more than doubled in teenagers and adolescents living in the United States.

There are probably similar figures in the United Kingdom and elsewhere in the wealthy nations of Europe and North America. In some of these countries, fatty liver is seen in about 10 per cent of all children and about 20 per cent of adults living in the United States. This makes it a major new threat to the liver of the urban affluent in those countries and is now certain to be replicated in those developing nations of the world where obesity is already becoming a public health issue.

A new disease condition affecting the second largest organ in the body has got to worry people.

Here at home, a small but growing number of reported abdominal ultrasound scans frequently make a note of a fatty liver as part of the general report on the findings at examination. Many physicians also routinely dismiss it with a wave of the hand, especially when there is an obvious pathology that seems the more pressing.

The growing body of evidence today is that it poses a threat to the liver in all age groups and is set to rise above the risk posed by the conventional causes of liver disease such as viral hepatitis and alcoholic liver cirrhosis. It is the only liver condition that shows a rise in incidence even as conditions brought about by Hepatitis B and C in particular, have seen a slowing of new infections.

This disease essentially causes the liver to swell with unwanted fat and the changes which it brings about are similar to those seen in heavy alcohol drinkers. In this case, however, those changes are caused by years of poor diet, inadequate exercise and excess weight.

There are no medications available now to treat this new phenomenon. A mere 30 years ago, there was no name even for this condition and practitioners in this part of the world have similarly been slow to realise that it represents a genuine problem. Many do not even warn their patients to try to do something about it and so they carry on as though there were no problem.

However, the weight of evidence suggests that, while there seems to be no definite treatment for now, it is a wise thing to exercise regularly, consume less refined sugar and eat more fibre in one’s diet, as well as vegetables and fruit. Some identified sufferers describe a range of symptoms including abdominal pain that is gnawing in character and often stabbing in nature. The pain is said to be crippling with alternative diagnoses ranging from acute pancreatitis to peptic ulcer disease being entertained as possible culprits for the pain.

This condition is now thought to be a strong risk factor for developing heart disease and Type 2 diabetes mellitus also called adult onset diabetes. While most people have a mild form of this disease, it is now known that between 10 and 20 per cent of all patients suffer a gradual deterioration in their liver function brought about by the gradual infiltration of the liver by liver fat. These changes lead in turn to alternate areas of inflammation and scarring that can slowly compromise the integrity of the organ, imperil its ability to act as a huge laboratory that helps the body get rid of toxic waste and eventually shut it down. The alternate inflammation and scarring progressively lead to the development of liver cirrhosis, even liver cancer and ultimately to liver failure.

Fatty liver strikes people of all races and ethnic groups. While it has a close association with obesity, not everyone who is obese has the condition. It is now certain that for sufferers, a reduction in the amount of calories consumed as well as a cut-down on the intake of soft drinks have been known to help some sufferers. The most important is exercising and the need to change one’s life-style as part of the survival strategies for this condition.

The statistics are very sobering indeed. At the University of California, Los Angeles, which has one of the largest liver transplant centres in the world, only about three per cent of all liver transplants in 2002 were necessitated by non-alcoholic liver disease. Today, that figure has shot up to 25 per cent of the total. And that is happening in a country which has a well-developed system for making organs available for transplantation to those who need it. In our continent, centres where organ transplantation can be carried out can be counted on the fingers of one hand. We are in trouble evidently because this mirrors the benign neglect of other aspects of the critical sectors of our health-care system.

The diagnosis of this condition is fairly straight forward. Non alcoholic fatty liver is often referred to as a silent disease. It thus joins other silent diseases like hypertension. There are no obvious symptoms in most people. When those symptoms occur, they usually consist of fatigue, which is a non-specific symptom, pain in the upper right abdomen, weakness, nausea and weight loss. Raised levels of Triglycerides, a type of fatty acid in the blood as well as evidence of insulin resistance, which is a precursor of diabetes, may point to the imminence of the disease. Blood tests which can show abnormally high levels of certain liver enzymes called transaminases will indicate that a liver injury has occurred. Imaging techniques such as the abdominal ultrasound scan will divulge an adequate amount of information. This is cheap, very much available and offers a painless and non-invasive means of mapping the liver for this condition.

The other means available for this is the Magnetic Resonance Imaging (MRI) of the liver which is more advanced that the ultrasound scan. It is, however, a very expensive examination technique and is not commonly available in much of Africa.