India's Next Major Lifestyle Challenge

Non-communicable diseases (NCDs), also known as lifestyle related diseases, usually affect individuals over an extended period of time. While cardiovascular diseases, cancer and diabetes are leading causes of death, liver disease is becoming increasingly prevalent in India, and is now a major lifestyle related disease in our country.

The liver is a large vital regulatory organ in our body, responsible for processing nutrients, removing waste products, maintaining temperature, synthesising important proteins for blood clotting and circulation, as well as producing bile that helps digest fats. From fatty liver to liver cirrhosis and liver cancer, the cases of liver disease in India are rising. According to recent estimates, liver disease is the 10th leading cause of death in India, and the numbers are expected to rise in the coming years. One study shows that liver disease kills more people than diabetes and road deaths in India.

Modern Lifestyle and Liver Disease

Liver disease can affect the liver in multiple ways to include inflammation (hepatitis), fatty change (steatosis and steatohepatitis), cirrhosis (severe scarring) and liver cancer. This has been termed metabolic liver disease or non-alcoholic fatty liver disease (NAFLD). Modern lifestyles, characterised by sedentary habits, limited exercise, unhealthy diet and increased alcohol consumption, are significant contributors to the development of liver disease. Another study puts the overall prevalence of NAFLD (most of which is asymptomatic fatty change) in the general population in India at close to 40 per cent.

The growth of unhealthy eating habits with the consumption of fat and carbohydrate containing food (fast food), which is high in calories and low in nutrients, is one driver for NAFLD. Processed foods and sugary drinks have led to a significant increase in the consumption of saturated and trans fats, which can increase the risk of developing fatty liver disease, which can eventually progress to cirrhosis and liver failure in a small percentage of patients. Alcohol is a major contributor to liver disease. The liver is responsible for breaking down alcohol, and excessive drinking can overload the liver, leading to irreversible damage. 

How Liver Disease affects you 

Liver disease is usually asymptomatic in its early stages, which means that it can go unnoticed until late in the disease process. When symptoms do appear, they may be quite subtle and vague to include fatigue, weakness, abdominal pain and jaundice. Liver disease can also impact mental health. If left untreated, there are severe consequences such as progression to cirrhosis, liver failure, hepatic encephalopathy (altered sensorium) and liver cancer. The late manifestations of cirrhosis may include internal bleeding into the bowel, fluid retention including ascites (collection of abdominal fluid), severe malnutrition, altered kidney function and severe blood clotting abnormalities.

Who Can Be Affected by Liver Disease?

Liver disease can affect anyone, regardless of age, gender or socioeconomic status. However, some factors can increase the risk of developing liver disease. These include a family history of liver disease, obesity, high blood pressure, diabetes, or a history of alcohol abuse. Additionally, excessive alcohol consumption, infection with hepatitis B and or C viruses, and certain medications can also contribute to the development of liver disease.

Some studies have also shown that men are more likely to develop liver disease than women and are at a higher risk of progressing to cirrhosis.  This is due to the fact that men tend to consume more alcohol and have a higher prevalence of obesity and diabetes. Men are twice as likely as women to have primary liver cancer, especially hepatocellular carcinoma.  While NAFLD is more common in men than in women of child-bearing age, it is frequently seen in women after menopause. Women are also more likely to have autoimmune diseases that can affect liver health. 

Preventive Measures

Regular exercise can help reduce the risk of developing liver disease by maintaining a healthy weight, reducing inflammation, preventing build-up of fat stores in the liver and improving insulin sensitivity. Eating a healthy, balanced diet including fruits, vegetables, whole grains, lean proteins, and healthy fats can help keep the liver healthy. It is important to limit the consumption of processed/sugary foods and drinks, as well as alcohol. Getting vaccinated for hepatitis B and C are other steps to prevent liver disease. Patients with a higher risk of developing liver disease or for those with early disease should get regular liver function tests and ultrasonography, to monitor their liver health.

Treatment of Liver Disease

The treatment of liver disease varies depending on the specific type and severity of the condition. In some cases, lifestyle changes such as a healthy diet, exercise, and abstaining from alcohol and drugs may be enough to manage the condition, reversing the fatty change and preventing progression to irreversible liver disease. In more serious cases, medication such as antiviral medications can be used to treat viral hepatitis, while corticosteroids and other drugs may be used to manage autoimmune liver disease. Progress is being made in the field of drug treatment of NAFLD, with several countries now approving newer drugs to reverse fatty change. Liver transplantation, where the diseased liver is removed and replaced with a healthy one from a living or a deceased donor, is considered for patients with irreversible end-stage liver disease. 

Liver transplantation is a life-saving surgical procedure for patients with end-stage cirrhosis, liver cancer, metabolic disease or acute liver failure, who have exhausted all other treatment options. In India we performed some 3800 such procedures in 2022, although the need is far greater (maybe up to 40,000 per year). The success rate of liver transplantation is high, with 85-90% of patients making a full long term recovery, with most patients going on to lead normal, healthy lives. 

Raising Awareness of Liver Disease and Organ Donation:

To address the rising tide of liver disease in India, we must work to raise awareness about the importance of liver health and take steps to prevent and recognise early liver disease. If diagnosed, proper treatment from a specialist team that addresses the early manifestations and underlying causes of liver disease is important. 

It is also important to raise awareness about organ donation to help save the lives of those suffering from end-stage liver disease, as this is the only treatment option once the disease becomes irreversible. Unlike in the West (where most patients receive organs from deceased donors), in India some 80 per cent of liver transplants involve living donors.  This is due to low numbers of deceased donors in India, where sadly our organ donation rates are amongst the lowest in the world. 

Prof Darius Mirza, Lead Consultant Liver & HPB Program, Apollo Hospitals (Western Region)