Often it’s the ailments we don’t see that throw our health into disarray. One such affliction is fatty liver disease. A potential silent killer, fatty liver disease lacks tangible symptoms in its earliest stages, making detection difficult for years together. But it affects a wide population, which is what makes the situation complex to navigate.
To understand the disease, its effects and treatments better, I chat with Dr Farooq Khan, consultant hepatologist at Dubai’s King’s College Hospital. Dr. Khan brings expansive knowledge of hepatology and gastroenterology from the UK to Dubai, where he has developed an advanced programme that offers to assess people with fatty liver and diabetes so the diseases can be managed on time. This is important since there presently seems to be an imbalance in the disease’s vast prevalence and the limited awareness around it.
One in three people we meet have fatty liver, while one in five people have diabetes (which increases the risk of fatty liver). Do people with fatty liver know they have it? “The part of the liver that’s affected by the fatty liver isn’t reflected straightaway in blood or liver tests,” Dr Khan explains. “Therefore, patients continue to live a very normal, asymptomatic life. By the time they know they have it, it’s far too late.” A rough guesstimate of when a person would find out they have fatty liver disease, without damage, could be 12 to 15 years later.
I have patients with fatty liver as young as 18 years old. So by the time they hit their prime 30s, they’ve got damaged liverDr farooq Khan
“I have patients with fatty liver as young as 18 years old. So by the time they hit their prime 30s, they’ve got damaged liver,” Dr Khan says, pointing to a key concern in the contemporary discourse of fatty liver disease. It worryingly affects a sizeable population of the youth. The youngest patient Dr Khan has served was 15.
Is the risk factor for liver disease linked to a particular gender or age? Certain studies suggest men are at a higher risk of disease progression, but largely, the risk factor remains similar for both men and women. As for age, Dr Khan posits that developing awareness as early as your teens is best.
“There are risk factors from late teens to early 20s that significantly contribute to what a dietary pattern is going to be,” he says. It’s an important forewarning, given the youth and university culture, wherein fast food is the go-to choice for many and healthy eating habits take a backseat. Dietary preferences in Gulf and Asian countries especially, along with the factor of genetics and epigenetics at play, too contribute to the frequency of liver disease in these geographies.
Would a person’s size put them at risk of getting liver disease in any way? “Waist circumference is actually one of the criteria on which we offer the assessment,” Dr Khan informs. The ideal waist size for women is under 91 cm and under 94 cm for men. The bottom line is this: If you hit 90 cms, you must consider getting assessed — regardless of gender. Measure your waist today!
For his part, Dr Khan claims to be wary of the link between higher Body Mass Index (BMI) and fatty liver. “We did a study in the UK last year – 26% of my patients had a fatty liver but normal BMI. These are patients who wouldn’t be called overweight or fat, but had visceral fat (which accumulated in the organs rather than the abdomen).”
Even so, BMI measurement is among the indicators that tell you to get assessed as soon as you can. Here are five risk factors you should know about, as relayed by Dr Khan:
- BMI over and above the ideal cutoff, which is 27 for Asia and the Gulf, and 30 for Caucasians.
- High cholesterol
- Family history of liver disease
- Abnormal liver tests
Dr Khan advises everyone to take a test once they hit 30, more promptly so if they notice any of the aforementioned symptoms. King’s offers an affordable liver assessment package priced at AED 1200, which includes consultation, ultrasound, blood tests for cholesterol, diabetes, liver and fibrous cancer. A team of specialists sit together to draw out a bespoke plan of action for each patient.
Ascertaining what stage of liver disease a patient is at is of prime importance to decide the kind of intervention they need. It varies for each assessment. Dr Khan explains, “If you have a fatty liver without damage and diabetes, you need about 5-10% of total body weight loss for you to avoid running into problems with diabetes, heart and liver. If you have a fatty liver and diabetes, with some level of damage, then you need diabetes specialists to look after you and the weight loss you need is about 10-15%.”
“If you’ve got liver disease and diabetes on top of fatty liver, then you need body weight loss of 20% or over to try and control it,” he says. “The end state is scarring or cirrhosis. Always remember, not everyone with a scarred liver needs a transplant.”
Fatty liver disease notably opens a multiway attack, even affecting other organs like the heart. The long-term mortality of people with fatty liver often results in heart diseases and strokes. To avert mishap tomorrow, the need is to make some lifestyle changes pronto. Balancing out a schedule with a healthy diet and proportionate exercise is important. Dr Khan suggests, “Small changes – such as reduced portions or changing from white flour to healthier options would reduce not only calories but the amount of carbs, sugars and fat.” Reducing fast food too would be a good first step.
As Dr Khan puts it, “As soon as you start losing weight, liver is the first organ that will melt the fat away – that’s the beauty of liver. It loves you — your liver is always, always on your side!”