In India, fatty liver disease has become an increasingly serious concern, and sedentary lifestyle and changing dietary habits can lead to its increasing prevalence. On World Liver Day, Dr. V. Sumanth Kumar, consultant for gastroenterology, shared insights on the causes, symptoms and treatment options of fatty liver disease, and the importance of maintaining a healthy lifestyle in an exclusive interview with DC.
What is the prevalence of cases involving liver damage or fatty liver that you see every day?
Fatty liver disease has become one of the most prominent liver diseases. We see many cases involving liver damage or fatty liver daily and the prevalence is increasing. It is associated with metabolic syndrome, which includes diseases such as diabetes type 2, dyslipidemia and hypertension. As lifestyles become more sedentary and dietary habits change, the prevalence of these diseases will also increase. They are all part of the spectrum, showing different manifestations in individuals – some diabetes, other dyslipidemia and some fatty liver.
Can fatty liver be reversed and what are the treatment options for different stages of the disease?
Fatty liver can be reversed, especially in the early stages. In most cases, 80-90% of cases are simple steatosis, which is completely reversible in lifestyle modifications. However, if it develops into advanced fibrosis or cirrhosis, it becomes irreversible, and liver transplantation is the only solution. Fatty liver is usually asymptomatic, especially in the early stages, and ultrasound of the abdomen is a cost-effective screening method. While this is not a gold standard survey, it is a great place to start.
What are the costs associated with liver transplantation? How to manage fatty liver without surgery?
Although liver transplantation is an expensive option, luckily most patients (90-95%) do not need it. Simple lifestyle changes can manage fatty liver, including moderate weight loss of 5-10% of your body weight. This is not only related to weight loss, but it is a healthy lifestyle with physical exercise, balanced nutrition and good sleep. Many patients who twist fatty liver continue to prefer this lifestyle, feeling lighter and healthier. Unlike alcoholics who often relapse, these patients tend to maintain healthy habits.
How does excessive drinking affect liver health?
Alcohol is mainly metabolized in the liver, and 90% of it enters directly into the liver. The liver can handle mild to moderate amounts, but over time, regular or excessive drinking of hepatocytes can damage the hepatocytes, leading to fibrosis, inflammation, and chronic liver disease. This is why the liver is the organ that is most affected by alcohol consumption.
What do you think about the health benefits of moderate alcohol consumption and intermittent fasting?
Any amount of alcohol is not healthy, and it is a myth of beer safety. A balanced diet is important. Similarly, intermittent fasting can be an effective weight loss tool, but it has advantages and disadvantages. I have seen patients with gastritis and recent studies have shown an increased mortality rate associated with the heart. I recommend that patients focus on increasing physical exercise, gaining 7 hours of sleep, and maintaining healthy eating habits rather than resorting to intermittent fasting.
What are the treatment options for different stages of non-alcoholic fatty liver disease?
For non-alcoholic fatty liver disease, treatment options vary by stage. In the initial stages, simple steatosis, moderate weight loss lifestyle changes, limiting alcohol intake, and screening for underlying conditions such as diabetes and thyroid abnormalities can help. A healthy diet, good physical exercise and 7-8 hours of sleep are crucial.
For Stage 2, NASH ((non-alcoholic steatohepatitis), we may use non-invasive studies such as LFTS and Fibroscan, as well as AfDA-approved drugs. However, once it develops into cirrhosis or end-stage liver disease, medications and physical activity, limited effects are required and liver transplantation may be required.
What is the success rate of liver transplantation in India and what is the related cost?
Liver transplantation is an expensive procedure that ranges from Rs 20 to Rs 25 lakh or more depending on the complications. However, the success rate has increased significantly, with current interest rates approaching 80-90%. Despite the cost, the results are promising, which is a viable option for those in need.
What lifestyle would you recommend to maintain healthy liver and overall well-being?
My message is simple: physical exercise, good sleep and healthy eating habits. A sedentary lifestyle, irregular sleep and junk food can cause damage over time, not only to the liver, but also to overall health. I recommend walking 3 km a day to reduce processed food intake and adopt healthy habits. It’s not about going to the gym, it’s about changing a sustainable lifestyle.
What is the youngest age for fatty liver? What screening tests do you recommend to detect early?
Fatty liver can affect anyone, no matter how old it is. I saw it among school-age children due to the sedentary lifestyle. For screening, I recommend ultrasound and liver function tests for less than $2,000. If abnormalities are detected, hepatic fibres can help assess risk. This is a noninvasive study that measures liver stiffness and guides further treatment.
What are the common challenges and side effects faced by patients after liver transplantation? How to ensure successful results?
Post-hepatic transplantation, if the patient maintains a healthy lifestyle, he can live a normal life. However, if the patient is an alcoholic, it is very likely to relapse, which is a common cause of transplant failure. We have seen this, especially among the rich and wealthy who continue to drink regularly. But procedurally, once patients stabilize after 3 months, they can live a relatively normal life span.
