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
References 1 Sarin SK et al . Liver diseases in the Asia-Pacific region : a Lancet Gastroenterology & Hepatology Commission . Lancet Gastroenterol Hepatol 2020 ; 5 ( 2 ): 167 – 228 . 2 World Health Organization . Hepatitis C . Fact sheet . www . who . int / news-room / fact-sheets / detail / hepatitis-c ( accessed March 2022 ). 3 Goel A , Seguy N , Aggarwal R . Burden of hepatitis C virus infection in India : A systematic review and meta-analysis .
J Gastroenterol Hepatol 2019 ; 34 ( 2 ): 321 – 9 . 4 Desikan P , Khan Z . Prevalence of hepatitis B and hepatitis C virus co-infection in India : A systematic review and meta-analysis . Indian J Med Microbiol 2017 ; 35 ( 3 ): 332 – 9 . 5 Li J et al . Prevalence , incidence , and outcome of non-alcoholic fatty liver disease in Asia , 1999-2019 : a systematic review and meta-analysis . Lancet Gastroenterol Hepatol 2019 ; 4 ( 5 ): 389 – 98 . 6 Sharma M et al . Drugs for Nonalcoholic Steatohepatitis ( NASH ): Quest
for the Holy Grail . J Clin Transl Hepatol 2021 ; 9 ( 1 ): 40 – 50 . 7 Issa D , Patel V , Sanyal AJ . Future therapy for non-alcoholic fatty liver disease . Liver Int 2018 ; 38 Suppl 1:56 – 63 . 8 Idalsoaga F et al . Non-alcoholic Fatty Liver Disease and Alcohol-Related Liver Disease : Two Intertwined Entities . Front Med ( Lausanne ) 2020 ; 7:448 . 9 World Health Organization . Global status report on alcohol and health 2018 : World Health Organization ; 2019 . 10 Rehm J , Samokhvalov AV , Shield KD .
Global burden of alcoholic liver diseases . J Hepatol 2013 ; 59 ( 1 ): 160 – 8 . 11 Kulkarni AV et al . Primary Norfloxacin Prophylaxis for APASL-Defined Acuteon-Chronic Liver Failure : A Placebo- Controlled Double-Blind Randomized Trial . Am J Gastroenterol . 2022 . 12 Kulkarni AV al . Letter to the editor : Living donor liver transplantation or deceased donor liver transplantation in high model for end-stage liver disease score – which is better ? Hepatology . 2021 ; 73 ( 6 ): 2619 – 20 .
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