Definition & Pathophysiology
- NAFLD: Accumulation of fat in the liver in individuals who do not consume significant alcohol.
- Mechanism: Dysregulation of liver metabolism leading to:
- Elevated liver enzymes: SGOT (AST) 10–40 U/L; SGPT (ALT) 7–56 U/L.
- Impaired insulin signaling, often linked with diabetes and obesity.
- Can progress to non-alcoholic steatohepatitis (NASH) and cirrhosis if untreated.
Relevance:
- GS-2 (Health & Nutrition): Lifestyle diseases, public health, preventive healthcare.
- GS-3 (Science & Technology / Health Infrastructure): NCD management, metabolic disorders, urban health challenges.
Risk Factors
- Metabolic conditions: Diabetes, obesity, insulin resistance.
- Lifestyle factors: Sedentary behaviour, irregular meals, high-calorie diet, lack of exercise.
- Age & gender: Increasingly reported in young adults (20–40 years), both men and women.
- Comorbidities: Pancreatic disorders, thyroid dysfunction, and dyslipidemia.
Epidemiology & Prevalence in India
- Estimated prevalence of NAFLD: 9–32% of the population.
- Progression to cirrhosis: ~1% in early-stage NAFLD; 1–25% in advanced NASH.
- State-wise prevalence (highest to lowest):
- Uttar Pradesh: 39.5%
- Haryana: 30.8%
- Karnataka: 25.8%
- Rising prevalence linked with urbanization, sedentary lifestyle, obesity, and diabetes epidemic.
Clinical Presentation
- Often asymptomatic initially, detected via routine liver function tests.
- Symptoms when present: Fatigue, abdominal discomfort, malaise.
- Laboratory findings:
- Elevated SGOT/SGPT levels (50–70 U/L observed in case study).
- HbA1c levels often >13% in uncontrolled diabetes cases.
Association with Diabetes
- Type 1 Diabetes (T1D): Autoimmune destruction of insulin-producing beta cells → insulin therapy required.
- Type 2 Diabetes (T2D): Insulin resistance; high circulating insulin levels contribute to fat deposition in the liver.
- NAFLD can precede diabetes diagnosis or worsen glycemic control.
Obesity & Sedentary Lifestyle
- Physical inactivity is a major contributor: Sitting for long periods, inability to exercise due to injury, occupational inactivity.
- Case examples:
- Sedentary work + knee injury → Grade 3 obesity → fatty liver.
- Moderate overweight + poor diet → gradual fat accumulation in the liver.
- Weight management and exercise are cornerstones of prevention and reversal.
Diagnosis & Management
- Diagnosis:
- Elevated liver enzymes (SGOT/SGPT)
- Imaging: Ultrasound, CT scan, or MRI for fat quantification
- Exclusion of alcohol-induced liver disease
- Management:
- Address underlying causes: diabetes control, weight reduction, lipid management.
- Lifestyle interventions: Low-carb diet, regular physical activity.
- Medications as needed for insulin regulation or metabolic syndrome.
- Prognosis: Reversible in early stages if underlying risk factors are controlled.
Public Health & Policy Implications
- NAFLD is increasingly a lifestyle disease affecting urban and middle-aged populations.
- Preventive measures:
- Promote healthy diet and physical activity in schools, workplaces, and urban planning.
- Screen high-risk populations: Obese, diabetics, and sedentary individuals.
- Healthcare system impact:
- Early detection prevents progression to cirrhosis and liver failure, reducing long-term healthcare costs.
- Awareness campaigns:
- Include NAFLD under NCD (Non-Communicable Disease) prevention programs.
- Encourage regular liver function testing, especially in diabetic and obese patients.
Conclusion
- NAFLD exemplifies intersection of lifestyle, metabolic disease, and public health.
- Highlights urban lifestyle challenges in India: Sedentary work, high-calorie diet, obesity epidemic.
- Emphasizes need for integrated healthcare approach: Screening, lifestyle modification, and chronic disease management.
