We are well aware of the effects of drinking too much alcohol on the liver. Fatty liver which has been on a rise in patients due to several lifestyle factors. Apart from heavy alcohol drinkers, NASH (Non-alcoholic steatohepatitis) and NAFLD (Non-alcoholic fatty liver disease) are two types of fatty liver disease that has been observed mostly in obese patients. NASH and NAFLD results in chronic inflammation, repair and healing within the liver and can lead to chronic liver disease and in some situations can result in new growths within the liver, some of which can turn into malignancy. Usually cancer of the liver occurs in a liver with cirrhosis but in NASH/NADLD these new growths can develop in the absence of chronic liver damage. These are also the cause of cirrhosis in around 30% of patients who come to be assessed for a liver transplant.

There is a common misconception that fatty liver can happen only to those who are fat or those who drink too much. In fact, fatty liver can even happen to people who appear lean or thin! According to a recent study conducted by IIJMR, NAFLDhas emerged as an important health problem in India, with an overall prevalence of 9-32 per cent among adults and 7.6 per cent in general paediatric population. It is considered as the most common cause of liver disease in paediatric population in the developed world. Children with NAFLD have a high prevalence of concomitant metabolic syndrome, increased risk for developing type 2 diabetes, and progression to end-stage liver disease.

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Very often we see individuals who eat a lot but seem to never get fat but this does not mean that the fat is not getting stored in the body. ‘Visceral fat’ or ‘Ectopic fat’ is a kind of fat that gets deposited on the organs of the body and it is this fat that starts to damage the liver over time, leading to liver cirrhosis and failure. When this fat starts to form over the internal organs in the body it can lead to many complications such as insulin resistance and diabetes.

Body Mass Index is one of the important indicators of fatty liver disease and usually people with high obesity, where body mass index is more than 25 are more prone to having fatty liver disease. A Body Mass Index of 18.5 to 25 is considered to be normal and below 18.5 is considered to be low. But there have been patients with fatty liver disease who have a BMI that is in the normal range or in the low range. In Indian populations particularly, it has been observed that people within a certain BMI range store more body fats compared to Western counterparts who fall in the same BMI range. BMI is a simple calculation that takes into consideration a person’s height and weight but it does not go into detail about how the fat is being distributed in the body.

It is indeed a blessing to not look very fat, but this doesn’t mean that they are following a healthy diet and exercising properly. In fact, they may be having a high amount of body fat which is not visible on the outside but is sitting on the organs inside such as the liver and pancreas. The fat also gets stored inside the skeletal muscles.Don’t take your leanness for granted – you may be a naturally lean person but your body may be storing fat in a different way.

However, this does not mean that all lean people are suffering from a silent health issue. What is important to keep in mind is to follow a good diet and exercise regularly even if you feel like you are lean and don’t need it. Regular health check-ups along with vigilance over your diet and lifestyle is key to avoiding any kind of lifestyle disease. A balanced diet with fibre, fruits, nuts and vegetables is crucial to give the body all the nutrients it needs to function. Avoid having too much fats or salts in your food regardless of the effect it has on your weight. It is also very important to maintain a regular regime of exercise – walking one hour per day is a good practice to follow. Try to incorporate stretches or 5 minute exercises that you can do at your desk if you are a working person.

It is worrying that fatty liver disease is starting to develop in very young children which raises questions on the kind of lifestyle habits that we are passing on to our future generations. Due to changing habits and the corporate lifestyle we are spending more time in sitting positions, paying very little attention to our diet and activity levels. Parents and young adults should become more conscious and responsible of their own lifestyle habits to ensure that the younger ones do not fall into the same patterns.

(Dr Rajiv Lochan J is senior consultant, HPB & Transplant Surgery, at Aster CMI Hospital)