Sponsored: Human albumin: Liver Disease SE Asia | Page 6

increased daily stresses have a great impact on the health of individuals . ⁵ Non-communicable diseases such as obesity , fatty liver , cardiovascular / cerebrovascular disorders in the young , allergic disorders and colonic diverticulosis are increasingly prevalent nowadays . Non-alcoholic fatty liver disease ( NAFLD ), recently renamed metabolic dysfunction-associated liver disease ( MAFLD ) is a spectrum of diseases ranging from simple fat accumulation in the liver ( steatosis ) to inflammation , to cirrhosis . Even in the absence of cirrhosis , NAFLD can lead to hepatocellular carcinoma similar to non-cirrhotic HCC seen in HBV infection . Non-alcoholic fatty liver disease ( NAFLD ) is an emerging global epidemic . ⁶ It is the most common cause of chronic liver disease globally . ⁷ The pooled prevalence of NAFLD in Asia is 30 % ( 95 % CI 28.13 – 31.15 ). ⁵ Rising incidences of obesity and diabetes mellitus account for a sharp rise in the incidence of NAFLD in the Asia-Pacific region . Furthermore , with the growing incidence of childhood obesity , NAFLD is increasingly being reported in adolescence . ⁸

Ways of reducing the burden of liver diseases attributed to NAFLD include :

• Promoting a generally healthy lifestyle

• Promoting healthy dietary habits , including a balanced diet

• Incorporating moderate-intensity aerobic physical activity into the routine ( 150 – 200min / week of brisk walking or stationary cycling , for example ).

• Avoid / minimise alcohol consumption ( risk threshold for males is 30g / d and 20g / d for women )

• Educating individuals detected on ultrasonography to adhere to dietary modifications and improve physical activity .

Alcohol According to the WHO in 2018 , more than 3 million deaths every year – representing around 5 % of global deaths – are attributable to alcohol consumption . ⁹ Alcohol consumption can cause death and disability relatively early in life . In the 20 – 39 year age group , approximately 13.5 % of the total deaths are attributed to alcohol . ⁹ Alcohol-attributable deaths among men total 7.7 % of all global deaths , compared with 2.6 % of all deaths among women . In 2010 , total alcohol per capita consumption among male and female drinkers worldwide was on average 19.4 litres of pure alcohol for males and 7.0 litres for females . ⁹ The annual per-capita consumption of pure alcohol is 14.6 litres ( 18.3 litres for men and 6.6 litres for women ) and the prevalence of heavy episodic drinking is 44.4 % ( 55.1 % in men vs . 21.4 % in women ) in India . ⁹ Regular alcohol consumption for ~ 2 weeks can lead to the development of fatty liver in almost 90 – 100 % of individuals . Continued misuse for > 6 months leads to alcoholic hepatitis in 10 %– 35 % of individuals , and 8 %– 20 % of individuals who misuse for 5 – 10 years develop alcoholic cirrhosis . Globally , alcohol-attributable liver cirrhosis is responsible for 493,300 deaths and 14,544,000 disability-adjusted life years . ¹⁰ The incidence of alcohol-related liver diseases is rapidly rising . Alcohol-related hepatitis is often

associated with high mortality and therapies to prevent the development of alcohol-related hepatitis and treat without any added risk of infections are crucial . ¹¹

Ways to prevent alcohol-related diseases include :

• Regulating the marketing and restricting the availability of alcohol

• Enacting appropriate drink-driving policies

• Reducing demand through taxation and pricing mechanisms

• Raising awareness of public health problems caused by harmful use of alcohol and ensuring support for effective alcohol policies

• Providing accessible and affordable treatment for people with alcohol-use disorders ; and

• Implementing screening and intervention programmes for hazardous and harmful drinking in health services .

Conclusions Liver diseases in South Asian countries are a common cause of morbidity and mortality . Early diagnosis , lifestyle interventions and appropriate timely treatment may reduce the morbidity and mortality attributed to CLD . Improving timely access to affordable healthcare should be one of the national policies of South Asian countries . ¹²