Obesity: It’s Not About How You Look: It’s How Your Liver Feels!- An Interview with Dr Desmond Wai Hepatologist at Gleneagles

Lifestyle Abuse: side effects of the good life

Economic growth and prosperity have created a population reaching out eagerly for hard earned benefits. However, not all the fruit of prosperity is good news for urban India. A  recent survey in New Delhi shows that 65% of the Capital’s adult population is overweight, and that children are increasingly vulnerable to the problems of obesity. Dr. (Desmond) Wai Chun Tao, Transplant Hepatologist and Gastroenterologist from Gleneagles Hospital, Singapore (Parkway Group), spells out the dangers to your body’s most important organ, the liver, for Vikesh Khetarpal

VKK The Indian heart is genetically prone to short circuits, how about the Indian liver ?
WCT You are lucky and healthy by way of liver and diseases associated with liver. Where 10 % Asians are suffering from Hepatitis B, only 2 % Indians are victim of Hepatitis B and only 1 % Indians are affected by Hepatitis C.

VKK How about the Indian Fatty Liver and the junk food we are getting so used to ?
WCT That’s a matter of concern. 25 to 30 % of urban India is a victim of this lifestyle condition. Termed non-alcoholic fatty liver disease (NAFLD), it is gaining prevalence due to rise in junk food. It is an important marker for diabetes and other metabolic diseases. Earlier it was associated only with excessive alcohol but today the situation is alarming as the liver inflammation is due to accumulation of fat in people who do not drink alcohol. Initially it is called ’steatosis’ and the fat may not affect liver functions but if left untreated and the fat stores are allowed to reach its peak and there is more fat pouring in then it strikes the liver. It can end up as fibrosis and then finally cirrhosis of the liver, which is an extreme form of NAFLD.

VKK What are the symptoms of NAFLD and who is more prone to it?
WCT To begin with there are no specific or significant symptoms. There may be lethargy, fatigue or simply dull ache around abdomen. As the condition progresses, there may be lack of appetite, weight loss, nausea and the eyes and skin may turn yellow. Earlier it was linked to alcoholics, but today, it is a lifestyle problem that occurs mostly in middle ages but it can also strike earlier if the lifestyle is faulty. However, alarm bells are ringing for children as well. A dangerous pattern is emerging as children too are found to be victims of NAFLD.

Non-alcoholic fatty liver disease (NAFLD) is on the rise. 30% of the Urban Indians have fatty liver and 1/3 of them may develop inflammation.

VKK Any cure or medication for NAFLD?
WCT Other than a shift to healthy lifestyle, there are no medications to check fatty liver. The good thing about NAFLD is that it is reversible. The trouble with fatty liver is that there are no early symptoms and when they do arrive it is late and the consequences may be serious.

VKK How about Living Donor Liver Transplant?
WCT For patients with end stage liver disease, liver transplantation can be a life saving treatment that can restore liver function and grant a new lease of life. However, many patients die due to non availability of donor liver. I advocate living donor liver transplant, because it quite safe for the donor where the risk to his life is less than 0.5 % and the morbidity rate is 25 to 30 % which can be managed within the hospitalization period. However, the benefit to the recipient is immense because the surgery can be conducted with a planned schedule and covering all the risks. As the efficacy of newer drugs has led to better survival of transplanted liver, the survival rate post transplant has gone up and has considerably less complications.

VKK How does this compare with cadaveric transplant?
WCT Living Donor Liver Transplant scores over cadaveric transplant because of the advantage that the donor liver is in good condition, as it is mostly taken from a young person and the surgical team has enough time and expertise to assess the donor. Most people do not volunteer for cadaver donations due to religious belief hence even after so many brain deaths, the cadaveric transplantation has not picked up any momentum. Kidney transplants have been carried out in Singapore for more than 35 years, with the first cadaveric kidney transplant operation performed on 8 July 1970. The Human Organ Transplant Act (HOTA) in Singapore was amended in 2004 to allow healthy organs to be taken from all brain-dead patients, not just accident victims. Now efforts are being made to remove the 60-year age limit on cadaveric kidneys.

Unlike India, Singapore allows donors who can be emotionally related to the recipient. Moreover, many patients with end stage liver disease prefer The Asian Centre For Liver Disease & Transplantation at Gleneagles Hospital, Singapore, which is the first private medical centre in Asia dedicated to the treatment of all types of liver disease.