Indians are today grappling with lifestyle-related disorders, and the number of people experiencing the challenges of liver diseases has been growing significantly. The liver, a remarkable organ known for its diversemetabolic functions and resilience, bears the brunt of unhealthy lifestyles, resulting in lower productivity and rising medical costs This threatens not only individual health but also has a significant impact on society and the economy. Although the burden of liver disease in India is difficult to assess, numerous epidemiological studies¹ suggest that Non-Alcoholic Fatty Liver Disease (NAFLD) has a prevalence of around 32% of the general population and a much higher percentage of people suffering with obesity, diabetes and dyslipidemia.

A healthy liver contains fat; however, a liver is classified as fatty when fat in the liver cells increases to 5-10% of the liver weight. NAFLD is the accumulation and build-up of excess fat in the liver cells and affects individuals who consume minimal or no alcohol. It is further classified into Non-Alcoholic Fatty Liver (NAFL) and Non-Alcoholic Steatohepatitis (NASH).

• NAFL is when an individual has simple fat build up that has no inflammation or damage
• NASH is when an individual has inflammation or cell damage in addition to the fat build up that may cause future complications

Even though NASH can have serious health implications, but the individuals suffering from the condition often have little to no symptoms. The condition remains silent for long periods, resulting in gradual inflammation and swelling, and the formation of scar tissue over time. Commonly known as fibrosis, this scar tissue blocks or limits blood flow within the liver, causing further damage that increases the probability of liver cirrhosis and liver cancer.

Due to the lack of recognizable symptoms and lack of awareness about NAFLD, many people are unaware of their condition. Further more, since there is no definitive cure for the condition once it develops, the focus thus shifts to prevention. In alternate cases, the management and control through healthy lifestyle choices, weight loss, and associated disease management decrease the mortality and morbidity due to NAFLD.

The Global Liver Institute launched a public education campaign International NASH Day in 2018 to raise visibility and urgency around NAFLD and its more advanced form, NASH. Recognizing the grave public health implications of NAFLD on the Indian population, the Government of India has integrated the disease into the flagship program for Non-Communicable Diseases (NCD), the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) to preempt preventive measures to counter this threat. A National Level Centre of Excellence has been set up to establish guidelines for diagnosis, increase awareness, train healthcare professionals and develop the monitoring and evaluation framework.²

While the screening for NAFLD is routine blood tests or radiologic investigations, a liver biopsy is required in critical cases. Even with a diagnosis, no medical interventions can reverse the disease. The only way forward is management and control of the disease. The NPCDCS has launched a media campaign to create awareness about NCDs nationwide using multiple offline and online media vehicles.³ Social and Digital platforms are leveraged for raising awareness, dispelling myths, and sharing information about liver diseases. Patient Support Groups and Patient Awareness Initiatives such as LivAlerthave been launched recently to provide healthcare professionals and primary caregivers opportunities to assist patients in monitoring and adherence to preventive and management measures. These platforms educate users about the symptoms, condition and risk factors and share valuable tips on diet and lifestyle modifications.

On International NASH Day, let’s LivAlert, build a stronger resistance against liver diseases and strive for a healthier future.

¹https://jcmlri.edu.in/assets/uploads/be31a35e622bf1da6b36389ff949e62b.pdf
²https://main.mohfw.gov.in/sites/default/files/OG%20print%20ready%20version%20_0.pdf
³https://main.mohfw.gov.in/NPCDCS

This article was first published in ET Health on 8^th June 2023