The Alarming Rise of Fatty Liver Disease in Young Adults

What is the prevalence rate of cases involving liver damage or fatty liver that you see on a day-to-day basis?

Fatty liver disease has become one of the most prominent liver diseases. We see a lot of cases involving liver damage or fatty liver on a day-to-day basis, and the prevalence is increasing. It’s linked to metabolic syndrome, which includes conditions like diabetes Type 2, dyslipidemia, and hypertension. As lifestyles become more sedentary and eating habits change, the prevalence of these diseases increases. They are all part of a spectrum, manifesting differently in individuals—some develop diabetes, others 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 its early stages. Most of the time, 80-90% of cases are simple steatosis, which is completely reversible with lifestyle modifications. However, if it progresses to advanced fibrosis or cirrhosis, it becomes irreversible, and liver transplant is the only solution. Fatty liver is often asymptomatic, especially in the early stages, and ultrasound abdomen is a cost-effective screening method. While it’s not the gold standard investigation, it’s a good starting point.

What are the costs associated with liver transplant, and how can fatty liver be managed without surgery?

While liver transplant is a costly option, fortunately, most patients—over 90-95%—don’t need it. Simple lifestyle modifications can manage fatty liver, including modest weight loss of 5-10% of body weight. It’s not just about weight loss, but a healthy lifestyle with physical activity, balanced nutrition, and good sleep. Many patients who reverse their fatty liver continue to prefer this lifestyle, feeling much lighter and healthier. Unlike alcoholics who often relapse, these patients tend to maintain their healthy habits.

How does excessive drinking impact liver health?

Alcohol is primarily metabolized in the liver, with 90% of it going directly to the liver. The liver can handle mild to moderate quantities, but regular or excessive drinking damages the liver cells, leading to fibrosis, inflammation, and chronic liver disease over time. That’s why the liver is the organ most affected by alcohol consumption.

What are your thoughts on the health benefits of moderate alcohol consumption and intermittent fasting?

Alcohol in any quantity is not healthy, it’s a myth that beer is safe. A balanced diet is what matters. Similarly, intermittent fasting can be an effective weight loss tool, but it has its pros and cons. I have seen patients develop gastritis, and recent studies show increased cardiac-related mortality. I advise patients to focus on increasing physical activity, getting 7 hours of quality sleep, and maintaining a healthy eating habit 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 stage, simple steatosis, lifestyle modifications with modest weight loss, limiting alcohol intake, and screening for underlying diseases like diabetes and thyroid abnormalities can help. A healthy diet, good physical activity, and 7-8 hours of sleep are essential.

For stage 2, NASH ((Nonalcoholic Steatohepatitis), we may use non-invasive investigations like LFTs and FibroScan, and the a FDA-approved drug. However, once it progresses to cirrhosis or end-stage liver disease, medication and physical activity have limited role, and liver transplant may be necessary.

What is the success rate of liver transplants in India, and what are the associated costs?

Liver transplant is a costly procedure, ranging from Rs 20 to 25 lakhs or more, depending on complications. However, the success rate has improved significantly, with current rates close to 80-90% in our country. Despite the cost, the outcomes are promising, making it a viable option for those in need.

What lifestyle changes would you recommend for maintaining a healthy liver and overall well-being?

My message is simple: physical activity, good sleep, and healthy eating habits. A sedentary lifestyle, irregular sleep, and junk food can cause damage over time, not just to the liver but overall health. I recommend brisk walking for 3 km a day, reducing processed food intake, and adopting healthy habits. It’s not about hitting the gym, but about making sustainable lifestyle changes.

What is the youngest age you have seen fatty liver in, and what screening tests do you recommend for early detection?

Fatty liver can affect anyone, regardless of age. I have seen it in school-age children due to sedentary lifestyles. For screening, I recommend an ultrasound and liver function test, which costs less than Rs 2,000 bucks. If abnormalities are detected, a liver fibroscan can help grade the risk. It’s a non-invasive investigation that measures liver stiffness, guiding further treatment.

What are the common challenges and side effects faced by patients after a liver transplant, and how can they ensure a successful outcome?

Post-liver transplant, patients can lead a normal life if they maintain a healthy lifestyle. However, if the patient is an alcoholic, there’s a high chance they will relapse, which is a common cause of transplant failure. We have seen this especially in the rich and affluent who continue to drink regularly. But procedurally, once the patient is stable after 3 months, they can lead a relatively normal life.