Fatty liver can lead to liver cancer in the long run

Fatty liver can lead to liver cancer in the long run It is important to follow a healthy diet free of alcohol to prevent build-up of fat in the liver New Delhi, 16 August 2017: Studies indicate an alarming increase in the number of people suffering from fatty liver. As per available statistics, 1 in 5 people in India have excess fat in their liver and 1 in 10 have fatty liver disease. This is a cause of concern as fatty liver can lead to liver damage and even liver cancer if undiagnosed and untreated. As per the IMA, about 20% of those with non-alcoholic fatty liver disease (NAFLD) are likely to get liver cirrhosis in 20 years. This percentage is akin to that among alcoholics. NAFLD is caused due to a build-up of fat in liver cells. The first stage of this disease is called simple fatty liver. Although excess fat builds up in the liver in this stage, it remains harmless and has no evident symptoms unless it develops into inflammation or damage. The second stage is called non-alcoholic stea to hepatitis (NASH) which is similar to alcoholic liver disease. However, those affected drink little or no alcohol. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “NAFLD may progress to cirrhosis and is likely an important cause of cryptogenic cirrhosis. As little as two drinks per day in those who are overweight (and one drink per day in those who are obese) is associated in hepatic injury. Liver cancer is associated with cirrhosis due to NAFLD and heart disease is the most common cause of death among patients with this condition. NAFLD is not caused by alcohol but its consumption can make the condition worse. The disease can stop or reverse, especially in the early stages. Once it progresses to cirrhosis, the liver becomes unable to function causing symptoms like fluid retention, muscle wasting, internal bleeding, jaundice (yellowing of skin and eyes), liver failure.” Some symptoms of NAFLD that emerge in the long run include fatigue, weight loss or loss of appetite, weakness, nausea, confusion and impaired judgment, pain in the centre or right upper part of the abdomen below the ribs, an enlarged liver, and patchy or dark skin on the neck or underarm. Adding further, Dr Aggarwal, said, “NAFLD is often diagnosed after liver function tests produce an abnormal result and other liver conditions such as hepatitis are ruled out. However, NAFLD can be present even when routine liver blood tests are normal. One needs to make certain lifestyle changes to prevent the disease from progressing to a more serious stage and lower the risk of having a heart attack or stroke.” Here are some simple lifestyle changes one can make to avoid this condition. • Maintain a healthy weight. • Consume a healthy diet rich in fruits and vegetables. • Get minimum of 30 minutes of physical activity every day. • Limit alcohol intake or avoid consuming it at all. • Only take medicines that are required and follow dosage recommendations.

Universal screening for alcohol misuse at hospitalization is a feasible strategy

Universal screening for alcohol misuse at hospitalization is a feasible strategy A study published online July 27, 2017 in the Journal of Hepatology has demonstrated that universal screening for alcohol misuse at the time of hospitalization to identify patients at risk of developing alcohol-related liver disease, is a feasible strategy. Researchers from the UK screened all admissions to the Acute Medical Unit of a large acute hospital using an electronic data capture system. At the time of admission, information about the amount of alcohol consumed, previous visits and or admissions and whether they were alcohol-related was recorded. Around 91% patients completed the screening; of these, around 3% of the patients were grouped as “increasing”, and 4% as “high” risk of alcohol harm. The high risk group had more frequent emergency room (ER) visits and higher re-admission rates; gastrointestinal bleeding, mental health disorders, poisoning and liver disease were the most common diagnoses for hospitalization. What this study showed was that it is possible to screen patients for alcohol misuse at hospitalization, identify patients with a very high unit consumption and then to refer them for appropriate intervention, potentially reducing the burden of alcohol-related harm. While, lower risk patients can be given brief advice by any trained healthcare professional This study assumes all the more importance because alcohol misuse is a major cause of preventable death. It also offers a solution to the unmet need to identify patients with alcohol-related liver disease at an earlier stage. According to the WHO, 3.3 million deaths (~6% of all deaths) globally every year are due to alcohol-related harm. It is all the more worrisome because alcohol consumption causes death and disability relatively early in life, particularly in the younger age group. Alcohol has been linked to many noncommunicable diseases, including alcohol-related liver disease and injuries. Overall 5.1 % of the global burden of disease and injury is attributable to alcohol, as measured in disability-adjusted life years (DALYs). Source 1. Westwood G, et al. Universal screening for alcohol misuse in acute medical admissions is feasible and identifies patients at high risk of liver disease. Journal of Hepatology, published 27 July 2017. Dr KK Aggarwal National President IMA & HCFI

A World Liver Day Initiative

A World Liver Day Initiative Excess alcohol bad for the liver • On World Liver Day, IMA warns that excess alcohol is responsible for fatty liver disease in a majority of people • Lifestyle changes key to a healthy liver New Delhi, 19th April 2017: Recent WHO (World Health Organization) statistics indicate that every year, about 2 lakh people die of liver ailments around the world. As per data, fatty liver disease is the third most common cause of chronic liver disease and affects 1 in 6 individuals. Just like the brain and heart, the liver is also a crucial organ that needs to be taken care of, more so if you are a heavy drinker. It has been found that about 25,000 lives can be saved by a liver transplant. However, data shows that at present, only 1,800 liver transplants happen every year globally. As in every year, 19th April is being celebrated as the World Liver Day this year as well. The liver has a very important role in the body’s digestive system. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "Anything that we eat or drink, including medication, must pass through the liver. It is the second-largest organ in the body and helps filter chemicals like drugs and alcohol from the blood; regulates hormones and blood sugar levels; stores energy from the nutrients and makes blood proteins, bile and several enzymes that the body needs. Keeping the liver healthy therefore is all about a healthy lifestyle. The basic thing about taking care of the liver is to avoid what’s bad rather than eat or drink something that nourishes this organ. Alcohol does more damage to the liver cells than one can imagine. It leads to swelling or scarring, later turning into cirrhosis, and can prove fatal to life." Alcoholic cirrhosis is the most common cause of cirrhosis, accounting for 40% of liver deaths from cirrhosis. The liver helps to remove alcohol from the blood through oxidation. However, once too much alcohol has been ingested for the liver to process in a well-timed manner, the toxic substance begins to turn into 'fatty liver'. This then is the early stage of alcoholic liver disease and can be seen in about 90% of people who drink more than two ounces (60 ml) of alcohol per day. Continuing to drink similar quantities of alcohol can lead to liver fibrosis and ultimately cirrhosis. Dr K K Aggarwal adds, "Fatty liver is reversible with timely medical intervention. However, it is also important to bring about certain lifestyle changes. If ignored, this condition can cause irreversible damage with liver transplant as the only end option. Therefore, it is important to avoid intake of alcohol, eat healthy, and get regular exercise. Timely hepatitis vaccines should also be considered to avoid any sort of complications to the liver." It is important to take care of the following points to keep the liver healthy. • Eat a healthy balanced diet and exercise regularly. • Eat out of all food groups, for instance, grains, protein, dairy products, fruits, vegetables, and fats. Eat fibrous food such as fresh fruits and vegetables, whole grain breads, rice, and cereals. • Avoid consuming alcohol, smoking, and drugs. They can permanently damage the liver cells. • Always make sure to consult your doctor before starting a new medication. Taking incorrect combinations of medicines can lead to liver damage. • Chemicals like aerosols and cleaning products can injure liver cells and therefore it is better to avoid extensive contact with these. • Keep a check on your weight as obesity can cause non-alcoholic fatty liver disease.

Excessive alcohol consumption continues to damage the society, economy and the health of the individuals

Excessive alcohol consumption continues to damage the society, economy and the health of the individuals It is the cause of death of over 2.5 million individuals every year (almost 4% of all deaths worldwide), and the third leading risk factor for poor health globally, accounting for 5.5% of disability-adjusted life years lost New Delhi, 04th October 2016: Excessive alcohol consumption and under-age drinking are common issues, which all countries globally continue to struggle with. The urgent need to raise awareness about the evils of alcohol consumption has been brought up by most National and International bodies during their annual meetings. However, till now, no strict action has been taken to curb the menace of alcohol. In a developing country like India, there’s an immediate need for framing a new set of policies, which will focus on reducing excessive alcohol consumption and framing new policies for harm reduction. Speaking on the issue, Padma Shree Awardee Dr KK Aggarwal, President Heart Care Foundation of India and President Elect IMA said, “The government should start with formulating new policies, which will focus on reducing the harm caused by excessive alcohol consumption. They should also impose some staunch legal and regulatory measures to limit the access to alcohol in cases of individuals who are below the certain age. The focus should be laid on creating new healthy and social policy interventions regarding alcohol, consumption by targeting vulnerable groups like high-risk drinkers. At present, the country already has some existing policies but they are not being properly implemented in the required areas. Bringing in international public health advocacy and partnerships to educate individuals about the ills can definitely help to free society from the shackles of alcohol consumption.” As far as our health is concerned, alcohol weakens the communication pathways of the brain, which causes sudden mood shifts, changes behavior and weakens the ability to coordinate. Excessive drinking can aggravate severe cardiovascular issues like cardiomyopathy – stretching and drooping of heart muscle, arrhythmias – irregular heartbeat, heart stroke and high blood pressure. Not only this, excessive consumption can cause liver inflammation problems like steatosis, or fatty liver, alcoholic hepatitis, fibrosis and cirrhosis. It is also a leading cause of obesity. A few measures that can be considered to reduce health burden of alcohol consumption • Increase alcohol prices, through taxation • Regulate access and availability of alcohol by limiting the hours and days of sale, the number and location of alcohol outlets and licensed premises, and the imposition of a minimum legal drinking age • Public authorities must strengthen the prohibition of selling to minors • Practicing alcohol marketing in a restricted way • Increase public awareness of harmful alcohol consumption

AAP updates guidelines for fetal alcohol spectrum disorders

AAP updates guidelines for fetal alcohol spectrum disorders The American Academy of Pediatrics (AAP) has updated guidelines to diagnose fetal alcohol spectrum disorders, published online July 27, 2016 in the journal Pediatrics. The new guidelines recommend evaluation of maternal alcohol consumption and that she should be interviewed carefully. Begin with more general questions about the child's health and then narrowing the focus to alcohol during and before pregnancy. The definition of alcohol exposure may include at least 6 drinks per week during at least 2 weeks of pregnancy, or at least 3 drinks per occasion on 2 or more occasions. Facial features should be evaluated. A positive result includes 2 of the following 3 criteria: short palpebral fissures, smooth philtrum, and thin vermilion border of the upper lip. If either facial features or maternal alcohol intake are positive, a neuropsychology evaluation is recommended. The guidelines also include a time line of the emergence of different developmental deficits, giving information on what to look for in infants, toddlers, and school-age children (Source: Medscape)

The safe limit of alcohol varies from one country to another

The safe limit of alcohol varies from one country to another New Delhi, July 25th, 2016: One to two drinks a day for women, and two to four drinks a day in men, are inversely related to mortality. This was stated by Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. The definition of a "standard drink" varies in different countries. A standard drink in the US is approximately 12 to 14 g alcohol. In Great Britain, a standard drink is 8 g alcohol. In Japan, it is 19.75 g and in India is 10 grams of alcohol. The blood serum tests: AST (SGOT), ALT (SGPT), and gamma-glutamyl transferase (GGT) are often abnormal in alcoholic liver disease. The most common pattern of abnormalities is a disproportionate elevation of serum AST (SGOT) compared to ALT (SGPT). This ratio is usually greater than 2.0, a value that is rarely seen in other forms of liver disease. The absolute values of serum AST and ALT are almost always less than 500 IU/L (and typically less than 300 IU/L). Higher levels should raise the suspicion of concurrent liver injury due to viral or ischemic hepatitis or acetaminophen use, even at therapeutic doses. Alcoholic liver damage can range from asymptomatic fatty liver to alcoholic hepatitis to end–stage liver failure with jaundice, coagulopathy, and encephalopathy. Many alcoholics first become symptomatic only when severe, life–threatening liver disease is already present. Even at this stage, abstinence can result in a significant reversal in some patients. Alcohol can lead to a variety of histopathologic changes in the liver ranging from steatosis to cirrhosis. Steatosis, alcoholic hepatitis, and possibly cirrhosis are reversible. A high prevalence (25 to 65 percent) of hepatitis C virus infection has been recognised in alcoholics, which can greatly accelerate fibrosis and associated morbidity. These patients tend to have more severe disease, decreased survival, and an increased risk of hepatocellular carcinoma. Fatty liver, or alcoholic steatosis, can occur within hours after a large alcohol binge.

Strong evidence that alcohol causes cancer at seven sites in the body

Strong evidence that alcohol causes cancer at seven sites in the body

Dr K K Aggarwal There is strong epidemiological evidence that alcohol causes cancer at seven sites in the body and probably others, says a new study in the latest issue of the journal Addiction reported 21st July, 2016. These sites include oropharynx, larynx, esophagus, liver, colon, rectum and female breast. A "dose-response relationship" between alcohol and cancer was observed for all these cancers, where the increase in cancer risk with increased average consumption is monotonic, either linear or exponential, without evidence of threshold of effect. The beverage type did not appear to influence any variation. The strength of the association with alcohol varies by site of the cancer, being particularly strong for mouth, pharynx and esophagus (relative risk in the range of 4–7 for ≥ 50 g of alcohol per day compared with no drinking) and less so for colorectal cancer, liver and breast cancer (relative risk approximately 1.5 for ≥ 50 g/day). Alcohol-attributable cancers at these sites were estimated to make up 5.8% of all cancer deaths globally. These conclusions are based on comprehensive reviews undertaken in the last decade by the World Cancer Research Fund and American Institute for Cancer Research, the International Agency for Research on Cancer, the Global Burden of Disease Alcohol Group including a comprehensive dose–response meta-analysis published last year in the British Journal of cancer. In the study, Jennie Connor, Dept. of Preventive and Social Medicine, University of Otago, New Zealand from New Zealand attempted to clarify the strength of the evidence for alcohol as a cause of cancer, and the meaning of cause in this context. Even without complete knowledge of biological mechanisms, the authors observed, the epidemiological evidence can support the judgment that alcohol causes cancer of these seven sites.