JULY, 2018 | The HEALTH issue: hepatitis 13
JULY, 2018 | The HEALTH issue: hepatitis 13
CREDIT: OUR PLACE IN THE WORLD
( From left to right) An illustration of a healthy liver, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis and cirrhotic liver.
Fatty liver disease
FATTY liver disease is characterised by access fat in the liver. It can be divided into alcoholic and non-alcoholic.
University of Malaya Faculty of Medicine, Department of Medicine Associate Professor Dr Chan Wah Kheong explained that alcoholic fatty liver disease is caused by significant amount of alcohol consumption.
“ We take that as more than 21 units per week for men and more than 14 units per week for women. One unit of alcohol is; for example – half a pint of beer, one glass of wine and one shot of spirit.”
Anyone who has a history of consuming a significant amount of alcohol and has a fatty liver, alcohol could be the cause.
On the other hand, there is nonalcoholic fatty liver disease( NAFLD) which occurs in a person that doesn’ t consume significant amounts of alcohol.
METABOLIC syndrome has five components; central obesity, high blood pressure, high triglycerides level, low HDL level and impaired fasting glucose, or frank diabetes.
University of Malaya Faculty of Medicine, Department of Medicine Associate Professor Dr Chan Wah Kheong explained that if the person, has any three of the five components, that person is considered to have metabolic syndrome. All these are risk factors for cardiovascular disease.
“ So, non-alcoholic fatty liver disease( NAFLD) is actually the liver manifestation of the metabolic syndrome. When somebody has some of these components, they are at a higher risk of having NAFLD. When a person has all five components, they are at 80 per cent risk of having NAFLD.”
In general, NAFLD is really the bigger problem because obesity is so common now and Malaysia is the most common obese country in South East Asia.
He explained that NAFLD patients are at an increased risk of having cardiovascular disease because it’ s closely associated with metabolic syndrome. But on top of that, some of the patients are at risk of liver related
Dr Chan Wah Kheong examining the editor for non-alcoholic fatty liver disease.
“ But as you see, obviously there are two causes due to the amount of alcoholic intake which overlaps.”
“ By street definition of NAFLD, there shouldn’ t be a significant amount of alcohol intake. If the person doesn’ t consume alcohol, the main cause for the fatty liver is over nutrition which is closely associated with obesity.”
“ Obesity has been on the rise, and along with it, obesity related diseases,
complications.
“ They are at risk of developing cirrhosis – if the liver is so damaged that there is scaring that the liver becomes modular.”
Complications associated with liver cirrhosis can lead to cancer. So these patients who has more severe liver disease, will have a higher risk of getting liver related complications which will lead to death.
“ NAFLD patients who are at a higher risk of this complications are those who have Non-alcoholic steatohepatitis( NASH).
“ The difference between NAFLD – those who have a steatohepatitis is fat in the liver compared to NASH where there is inflammation, swelling of liver cells( ballooning).
Patients with NASH are at a higher risk of getting scaring in the liver or fibrosis which eventually would lead to cirrhosis as well as liver cancer.
Think before you toast.
Practical tips to care for your liver
• CONSUMING to much of alcohol can damage liver cells and lead to cirrhosis, which is deadly.
• Eat a healthy diet and exercise regularly. Keeping your weight under control helps prevent non-alcoholic fatty liver disease away.
• Be careful when consuming certain medications. Some drugs, when taken for a long period of time can cause liver problems.
• Do not take medicines and consume alcohol at the same time.
• Learn how to prevent viral hepatitis. Abstain from eating or drinking water that is contaminated.
• Don’ t share items like toothbrushes, razors or needles.
• Limit the number of sex partners and always use protection.
• Don’ t breathe in toxins such as products containing insecticides and aerosol products.
• Don’ t smoke as additives in cigarettes can damage your liver.
• Exercise precaution when consuming dietary supplements such as cascara, chaparral, comfrey, kava, and ephedra, milk thistle seed, borotutu bark and chanca piedra.
• Research shows that coffee can lower your risk of getting liver disease.
Five components of a
Statistics metabolic syndrome
RAIHAN R, Mohamed R, Hasan MRA, Rosaida MS. Chronic Viral Hepatitis in Malaysia:“ Where are we now?”
The various components of a metabolic syndrome.
including non-alcoholic fatty liver disease, which is considered as the liver’ s manifestation of the metabolic syndrome.”
Metabolic syndrome is basically a constellation of risk factors for cardiovascular disease which include central obesity. In Asians, it is defined as a waist circumference of 90cm in men and more than 80cm in women.
“ Other components of the metabolic syndrome will be hypertension, high blood pressure, high triglycerides level in the blood, high density lipoprotein cholesterol level, impaired fasting sugar – impaired glucose tolerance of frank diabetes( where a person is frankly diabetic).”
“ When a person takes a fasting sugar, normally, it is less than 5.5. If it’ s more than seven, the person would be expected to have diabetes. But there’ s a range in between that which is called impaired fasting glucose. So, it’ s not normal but it’ s not diabetes range yet,” he said.
Euroasian J Hepato-Gastroenterol 2017; 7( 1): 65-67
Globally
400 million people live with hepatitis B virus( HBV) or hepatitis C virus( HCV) infection
1.4 million people die every year from complications of viral hepatitis
Malaysia
1 million people are chronically infected with hepatitis B virus( HBV)
2.5 % of the adult population are positive for antibody to hepatitis C virus( HCV)
World Health Organisation 2017“ Liver Disease Deaths in Malaysia”
Liver disease deaths were 2,286 or
1.65 % of total deaths.
The age adjusted death rate is 9.18 per
100,000 of population
AsiaOne. com“ The facts about fatty liver”
17 per cent of the population is believed to be afflicted with fatty liver disease.