By Shweta Sharma
New Delhi, Oct 25 (IANS): Little did 52-year-old Sheila Joshi (name changed), suffering from obesity-related uncontrolled diabetes know that her condition was leading to a damaged liver.

Joshi is not the only one, say health experts, adding that Indians largely remain unaware of the condition and wake up to it very late.

"Indians are of the primitive ideology that liver diseases are mainly a problem of the alcoholic population and does not easily affect non-drinkers. But recent studies and awareness of Non Alcoholic Fatty Liver Disease (NAFLD) clearly state that this disease is not only linked with drinking alcohol," Tarun Mittal, general surgeon, Laproscopic, Robotic and Bariatic surgeon, Sir Ganga Ram Hospital, told IANS.

Explaining the causes, Vikas Singhal, executive consultant, minimal access surgery, Gastroenteritis and Bariatric surgery, Jaypee Hospital, Noida told IANS: "Obesity and diabetes are major risk factors for NAFLD. In fact, NAFLD is so closely associated with obesity and diabetes, it can be used as a marker for patients who are at risk of developing diabetes, heart disease and stroke in the future if they do not start taking preventive measures early."

Agreed Mittal who said the other reasons are malnutrition, pregnancy related acute fatty liver, drugs, toxins and some other inflammatory bowel diseases and even HIV and Hepatitis C.

According to Pradeep Chowbey, vice chairman, Max Healthcare and director, minimal access, metabolic and bariatric surgeon, fatty liver disease are often diagnosed on ultrasound when done for "unrelated symptoms" such as pain in abdomen or pregnancy.

"Some people with excess fat in the liver simply have what's called a fatty liver. Although this is not normal, it's not serious if it doesn't lead to inflammation or damage. However, NAFLD, if not managed properly, specially associated with obesity can lead to very serious liver problems known as nonalcoholic steatohepatisis (NASH). The liver may enlarge and, over time, liver cells may be replaced by scar tissue," Chowbey told IANS.

Health experts said that an enlarged liver due to fat deposition is being diagnosed incidentally in 30 to 40 percent of ultrasound scans done for other reasons. It usually starts in middle age but now has even been noted in children.

They add that in around 10 to 15 percent patients it progresses to further stages of liver damage ranging from Non Alcoholic Steato-Hepatitis (NASH) - which is essentially inflammation of the liver - subsequently fibrosis (scarring) and eventually cirrhosis.

So, how can the condition be best treated?

"Regular exercise, brisk walk, proper control of diabetes and obesity are some measures. Surgery for obesity also improves fatty liver. The current best treatment of NAFLD and nonalchoholic steatohepatitis is weight reduction.

"Bariatric surgery is accepted as a treatment for obesity and results in better control of metabolic factors, including diabetes, than does medical therapy alone," Ashish Bhanot, senior bariatric surgeon, Nova Specialty Hospital, told IANS.

Chowbey added that "in severely obese people with fatty liver disease, endosurgery (minimally invasive surgery) is the only treatment known for cure".

"The treatment is change in dietary habits and exercise before irreversible liver damage. Weight loss with a healthy diet high in protein and low in carbohydrate and fats is the key.

"Adequate management of diabetes, hypertension are other factors. Stopping alcohol is also a must as alcohol can compound liver damage. For patients who meet criteria for bariatric and metabolic surgery, bariatric surgery has been seen to cure NASH in over 80 percent of patients," said Singhal.

Suggesting precautionary measures, he said a healthy diet, which is high in proteins, low in carbohydrates and fats.

"Eat raw fruits. Avoid fruit juices, coke, pepsi and other sugary drinks. Eat three healthy meals and two healthy snacks in between. Reduced alcohol consumption not more than one to two drinks, no more than once or twice a month. Exercise daily for minimum 60 minutes. It doesn't have to be done at one sitting," he said.