The Mounting Burden of Non-Alcoholic Fatty Liver Disease (NAFLD) and its Significance for Public Health

Introduction:

‘The Liver’ our body’s remarkable organ, the hepatic apparatus weighs around three pounds. This Cuneal Reddish-Brown organ located in the upper right quadrant of our abdomen, executes more than 500 core duties. Some functions include detoxification of blood, bile production, nutrients & hormone metabolism, storing essential vitamins (A, D, E, K, B12) and minerals (Iron and Copper), bilirubin elimination, and maintaining homeostasis. Any abnormal functioning of liver deeply disrupts the body’s homeostatic balance. Non-Alcoholic Fatty Liver Disease (NAFLD) with its more severe form, Non-Alcoholic Steatohepatitis (NASH) has emerged as the most common cause of chronic hepatic dysfunction globally.

Fatty Liver Disease:

Fats can build up in the liver due to various factors like unhealthy lifestyle, any medical condition or even some medications lead to the ailment called fatty liver (Steatosis). When excess fat builds up in the liver, it can result in adverse effects of steatosis from mild to severe inflammation and even liver failure. These damages to the liver, if left unheeded, can progress from NAFLD to its severe form NASH, and subsequently to fibrosis, cirrhosis, and liver failure. The key distinction of NAFLD is that this fat buildup is unrelated to alcohol consumption. 

NAFLD: A Silent Epidemic

In today's world, poor dietary habits deteriorate the quality of life even in well-urbanized settings. The ubiquity of NAFLD is increasing due to underlying epidemics such as obesity, and type 2 diabetes which are caused by unhealthy eating patterns.

We will explore the causes, symptoms, and treatments of NAFLD in this article.

Causes:

One of the most common causes of NAFLD is obesity. People with an excessive body weight with an elevated BMI threshold directly contribute to fatty liver. Other factors like diabetes mellitus, genetics, insulin resistance, and some medications significantly exacerbate the condition of NAFLD.  

Symptoms:

NAFLD is typically asymptomatic in its early stages. However, some patients may experience non-specific symptoms such as fatigue, bloating, an enlarged liver, abdominal discomfort, and sleep disorders. Patients with advanced liver disease, including cirrhosis (a common outcome of unmanaged NASH) and severe fibrosis, often present with the following symptoms:

 * Reduced appetite

 * Vomiting

 * Jaundice

 * Itchy skin (pruritus)

 * Abdominal swelling (ascites)

 * Easy bruising or pinpoint bleeding

 * Excessive bleeding 

Diagnosis:

As NAFLD progresses without overt manifestations, it is often not suspected due to lack of symptoms.

General blood tests, including lipid profile, liver enzyme test, and liver function tests, can identify indicators of liver damage in NAFLD.

Diagnostic imaging procedures like Magnetic Resonance Imaging (MRI), Abdominal Ultrasound, Computer Tomography (CT), and Magnetic Resonance elastography (stiffness of liver tissue is measured) are used to identify fatty liver disease. 

Advanced stages of NASH are evaluated through liver biopsy.  This invasive procedure includes some risk factors, involving the removal of a small amount of liver tissue via a needle that is inserted through abdominal skin. While biopsy tests can determine definitive stages of fibrosis, imaging-based tests can only estimate the stages and help rule out other health conditions. 

Treatments:

Prescribed treatment plans that are based on a patient's lifestyle habits can bring marked progress in reduction of hepatic steatosis. Modern world food habits adversely affect diet patterns.  Such practices encompass consumption of processed foods, and sedentary lifestyle. NAFLD can be treated straightforwardly by changing unhealthy routines into healthy living.

The primary approach to treat fatty liver is weight-loss therapy that is accompanied with balanced diet. Losing body weight helps to reduce the accumulation of fats in liver. Various weight-loss ranges are recommended by American Association for the Study of Liver Diseases to achieve favourable results in alleviating NAFLD.  Around 5-10% weight loss is recommended to reduce fat and inflammation in the liver.

A regimen of weight reduction combined with nutrient-rich diet aids in successful NAFLD treatments. 

Medicaments:

Currently, there is no specific drug for treating NAFLD. Nonetheless, drugs used to treat conditions like diabetes, and cholesterol are found to have positive impacts in treating NAFLD. For instance, diabetes medications like Metformin, and Dapagliflozin have shown promise for managing NAFLD in type 2 diabetes patients. These medicines improve insulin sensitivity and carbohydrate metabolism thereby helping to reduce fatty liver. 

Assessment of progression:

* Consistent observation through blood tests, imaging tests, and liver biopsies helps estimate the severity in NASH.

* End-stage cirrhosis requires hepatic transplantation to replace a diseased liver with a healthy donor organ.

Overall Public health Strategies for NAFLD:

On a world scale, NAFLD has made an appearance as a serious health concern. NAFLD is highly associated with underlying metabolic conditions like diabetes, metabolic syndrome, and obesity. The pathogenesis of NAFLD can lead to severe stages like NASH, cirrhosis, and ultimately liver failure. The progression to these severe outcomes ultimately results in socio-economic strain in the population. Due to lack of a proper pharmacological approach for NAFLD, the key foci of public health strategies for this disease are early detection, prevention, risk factor modification, and access to care.

Health-Promoting interventions:

By practicing the following elements, prevalence, and impact of NAFLD among the people can be decreased:

* Reinforcing wholesome diet habits enhances lifestyle quality.   Healthy diet should be rich in vitamins, minerals, and lean proteins with the avoidance of processed food intake.

* Implementing weight management programs through regular exercise/physical activity helps improve insulin sensitivity and metabolism. 

* Even though NAFLD is non-alcoholic, public health campaigns for eradicating alcoholism are recommended for those who are alcoholic. Excessive alcohol consumption can aggravate liver damage in people with the liver disease. 

* Public education and awareness campaigns on NAFLD are crucial for public. These programs help people manage their co-existing conditions like obesity, diabetes, and hypertension, as these conditions are major drivers of NAFLD progression. 

Ongoing parameters for NAFLD: Public health monitoring

Research and surveillance on NAFLD key parameters provide insights into the current state of the disease and help identify emerging trends in the disease and its impact on affected people.

Some core contexts are:

* Systematic collection of population-level data on the occurrence of fatty liver disease.

* Tracking the prevalence and risk factors of obesity, type 2 diabetes, metabolic syndrome, and dietary patterns. 

* Understanding the patterns of healthcare utilization and costs associated with diagnoses, disease management, and treatment plans of NAFLD among affected populations.

* Evaluating the influence of social health policies and health regulation laws on NAFLD prevalence and outcomes within specific cohorts.

By persistently scrutinizing these parameters, Health regulatory bodies can analyse and refine the potency of their strategies to deal with the growing challenge of NAFLD. 

Conclusion:

Disease like NAFLD plays a crucial role in deteriorating patient's health, thereby it contributes to a significant public health burden.  Lack of essential knowledge on health & poor lifestyle choices has direct impact on development of the disease. Common conditions like obesity, diabetes, and cholesterol are critical comorbidities that should be managed with proactive care to prevent the increase in severity of NAFLD. Many healthcare authorities are constantly investigating the disease through various ongoing researches. NAFLD is a potential challenge for doctors and scientists due to the absence of specific, approved medication for the disease. Advanced diagnostic tools are helpful in assessing the severity of the disease.  Invasive methods such as surgery, and organ transplantation are utilized for managing severe complications of NAFLD.  Therefore, cornerstone of NAFLD management involves embracing healthy lifestyle and cultivating good eating habits together with informed health choices and effective disease management. This can aid people to manage and prevent NAFLD progression.