- Prelims: Current events of national importance, WHO, NCDs, G20, age tax, mortality, fertility rate, AI, robotic surgery etc
- Mains GS Paper I & II: Development and management of social sectors/services related to Health and education etc
ARTICLE HIGHLIGHTS
- The theme for International Fatty Liver Day this year, an awareness initiative observed annually in June, is ‘Act Now, Screen Today’.
INSIGHTS ON THE ISSUE
Context
Health:(WHO)
- A certain totality of health to the realms of mental and social well-being and happiness beyond physical fitness, and an absence of disease and disability.
- We cannot achieve health in its wider definition without addressing health determinants.
Non-communicable Diseases(NCD’s):
Liver diseases:
- They are predominantly associated with excessive alcohol use and this remains an important cause of advanced chronic liver disease.
- The emergence of a silently growing threat to liver health — non-alcoholic fatty liver disease.
- Fatty liver is closely linked to metabolic health, cardiac health, and a risk for developing cancers.
- This disorder has been reclassified and is known as ‘Metabolic dysfunction-associated steatotic liver disease’ (MASLD).
- It has resulted in a paradigm shift in how we approach liver health.
- The key is to screen, test, and treat.
Fatty liver disease:
● MASH (Metabolic dysfunction-associated steatohepatitis), a progressive form that causes liver inflammation and scarring
○ It is expected to become the most common cause of chronic liver disease and the leading indication for liver transplantation.
○ The global prevalence of MASLD is estimated at 25-30%.
● Meta-analysis(2022): It revealed that in India, among adults, the pooled prevalence of fatty liver was 38.6%, while among obese children, it was around 36%.
- There is a close link between fatty liver disease and metabolic syndrome, including obesity, diabetes, high blood pressure, and abnormal cholesterol levels.
- Individuals with these conditions have high MASLD prevalence rates:
- 5%-59.7% for diabetes
- 6%-95% for obesity
- 73% for severe metabolic syndrome.
Fatty liver and metabolic syndrome:
- Consuming excessive carbohydrates, especially refined carbs and sugars, worsens these conditions by causing metabolic problems.
- When the body has too much glucose, it increases insulin production to help cells absorb the glucose.
- Constantly eating too many carbs causes persistently high insulin levels, leading to insulin resistance, where cells become less responsive to insulin.
- Insulin resistance disrupts normal metabolism and promotes the conversion of excess glucose into fatty acids, which are then stored in the liver.
- The liver cells fill up with fat, leading to fatty liver.
- Over time, this continuous damage affects the liver’s ability to function properly
- progressing from simple fatty liver to more severe conditions such as steatohepatitis and cirrhosis, which are hallmarks of MASLD, and may require a liver transplant.
Issues:
- Despite this growing burden of fatty liver disease, it often goes undetected as there is usually no warning or symptom in the early stages.
- Diagnosis is usually made at an advanced stage, often when significant liver damage has already occurred.
What steps need to be taken?
- A comprehensive health screening that includes a thorough history, physical examination, blood tests, and an ultrasound of the abdomen.
- Physical examination will include height, weight, body mass index (BMI), abdominal girth, and waist-to-hip ratio to assess visceral fat.
- Blood tests to cover cardio-metabolic risk factors include a blood count, sugar profile, blood lipid profile, liver function tests, and kidney tests.
- An ultrasound of the abdomen is an important test to screen for liver disease and an important first step to diagnose fatty liver.
- It is often missed or not included in many health checks, because of the limited availability of radiologists as well as stringent regulatory approvals.
- Advanced liver tests will include liver fibrosis assessment to look for liver scarring
- most accurately done by using newer technologies such as vibration-controlled transient elastography.
- This is a non-invasive tool and it measures liver stiffness to assess early stages of liver fibrosis.
- It can be used to regularly monitor the progression and responses to treatment.
- ultrasound, comprehensive metabolic screening, and elastography — form an integrated approach to effectively detect and manage liver diseases at an early stage.
Case study:
- In a cohort of 50,000 people screened at Apollo Hospitals:
- Amongst the 33% that had fatty liver, as observed using an ultrasound of the abdomen
- only one in 3 had elevated liver enzymes in their blood test.
Way Forward
- The selection of screening tests and the frequency with which they are performed should be personalized.
- This decision should be based on factors including an individual’s risk factors such as family history, lifestyle, and pre-existing health conditions.
- Clinicians should not make generic assumptions given the patient’s age or physical markers alone.
- We are increasingly witnessing non-communicable diseases break traditional stereotypes and impact very diverse people, including children.
- Multiple factors affect liver health, necessitating integrated strategies that combine dietary modifications, regular physical activity, and effective weight management to mitigate liver disease risks.
- The liver is a ‘silent organ’ that typically does not exhibit noticeable signs of damage until it reaches an advanced stage.
- It is important that we are aware of the impact our lifestyle choices make in the long run.
- We need to take active control of our health, be aware of what we consume, and go for frequent screenings because the groundwork for a happy life begins with good health.
- To guarantee that everyone may live a healthy life, attaining health equity necessitates a comprehensive strategy that goes beyond legislative reform to address the socioeconomic determinants of health.
QUESTION FOR PRACTICE
Besides being a moral imperative of the Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyze.(UPSC 2021) (200 WORDS, 10 MARKS)
