SUR­PRISE DI­AG­NO­SIS

Over­weight and obese peo­ple are at risk of de­vel­op­ing non-al­co­holic fatty liver dis­ease, but many don’t know it

Montreal Gazette - - YOU - VIC­TO­RIA LAMBERT

Hi­lary Todd was as­ton­ished when doc­tors told her in De­cem­ber 2015 that she needed an ur­gent liver trans­plant. “I felt fine,” she says, “I told them, I’m not ill. I re­ally didn’t be­lieve it.” Yet Todd, 53, had non-al­co­holic fatty liver dis­ease (NAFLD) caused by a buildup of fat which, over time, had caused her liver to fail. Hav­ing never con­sumed al­co­hol, and be­ing “over­weight, but fit from run­ning around the play­group I ran and from look­ing after my own three chil­dren,” the di­ag­no­sis “was a sur­prise” — all the more so when she was told that she needed “to get on the trans­plant list while I was still well enough to have the op­er­a­tion. By the time I was ready in Oc­to­ber 2016, my main he­patic por­tal vein was so blocked, I was two weeks away from be­ing in­op­er­a­ble.” Todd had an ad­vanced case of fatty liver dis­ease — in up to 12 per cent of cases, NAFLD de­vel­ops into non-al­co­holic steato­hep­ati­tis, or NASH, which can lead to se­vere scar­ring and liver can­cer. Her ini­tial di­ag­no­sis, how­ever, is sur­pris­ingly com­mon; though most peo­ple as­so­ci­ate the con­di­tion with ex­ces­sive al­co­hol in­take, the British Liver Trust es­ti­mate that more than one in five peo­ple in the U.K. are now in the early stages of NAFLD. (Ac­cord­ing to the Cana­dian Liver Foun­da­tion, 23 per cent of obese Cana­di­ans are at risk of de­vel­op­ing se­ri­ous liver dam­age from fatty liver dis­ease. NAFLD is the most com­mon liver dis­ease in Canada, af­fect­ing more than seven mil­lion peo­ple.) Most will have no idea they are even at risk. “Al­co­hol is still the most com­mon cause for ad­mis­sion to hos­pi­tal with liver dis­ease,” ex­plains Dr. Phil Har­ri­son, con­sul­tant hema­tol­o­gist at Lon­don Bridge Hos­pi­tal’s Liver Cen­tre, “but now it’s closely fol­lowed by NAFLD.” He puts this down to the rise in obe­sity and cases of Type 2 di­a­betes — both of which pre­dis­pose to NAFLD, lead­ing the con­di­tion to be­come “a se­ri­ous prob­lem, al­most an epi­demic,” says Har­ri­son. Most cases will have a body mass in­dex (BMI) of over 30, clas­si­fy­ing them as obese. But NAFLD also shows up in those with BMIs of 25 to 30 — the over­weight cat­e­gory. “NAFLD takes up the bulk of our out­pa­tient clinic work,” says Jonathan Fal­low­field, se­nior clin­i­cal fel­low and honorary con­sul­tant hema­tol­o­gist at the Univer­sity of Ed­in­burgh. “Over the last decade, we’ve no­ticed it be­com­ing more prom­i­nent, and it will soon be the most com­mon rea­son for liver trans­plants.” He says that many “don’t re­al­ize the sig­nif­i­cance” of what is hap­pen­ing and are only usu­ally di­ag­nosed after be­ing “picked up with ab­nor­mal liver tests after be­ing in­ves­ti­gated for some­thing else. They’re of­ten over­weight or obese, but they may have no symp­toms.” Men are more likely to suf­fer NAFLD than women, with older peo­ple, lower-in­come fam­i­lies and those who drink too much most at risk. It can af­fect any­one, how­ever, and last sum­mer it was re­vealed that fatty liver dis­ease was a con­tribut­ing fac­tor to the death of singer Ge­orge Michael. It is not fully un­der­stood yet, Har­ri­son says. “The fat which gets de­posited is not the same as fat we see around the waist. It gets into the liver cells where it can stop the liver do­ing its work of detox­i­fy­ing. “Of­ten, liver dis­ease pro­gresses in­sid­i­ously for years build­ing into in­flam­ma­tion. In time, the worst symp­toms can be brain con­fu­sion, jaun­dice or bleed­ing from swollen veins in the esoph­a­gus.” Bleed­ing was the first symp­tom Todd suf­fered, but as it started when she was 43 — most peo­ple are not con­sid­ered at risk un­til they are in their 50s — doc­tors couldn’t de­tect an un­der­ly­ing prob­lem. After a fam­ily trip to the lo­cal swim­ming pool 10 years ago, “I threw up a sink full of blood in the chang­ing room. It was fright­en­ing,” Todd says. She was taken to hos­pi­tal with a sus­pected bleed­ing ul­cer and suf­fered a stroke the next day. After three days in in­ten­sive care, she was di­ag­nosed with esophageal varices, but liver biop­sies — the most ef­fec­tive way to di­ag­nose the con­di­tion — were in­con­clu­sive. She spent the fol­low­ing seven years be­ing mon­i­tored reg­u­larly, but it was only in late 2015, when a blood test in­di­cated her con­di­tion had de­te­ri­o­rated, that Todd was placed on the trans­plant list. As liver trans­plants are the only cure for ad­vanced liver dis­ease, the main aim of doc­tors is to en­cour­age weight loss. When his 69-year-old mother was di­ag­nosed with liver dis­ease, Asanka De Silva be­gan de­vel­op­ing LivOn!, a cof­fee drink low in calo­ries, sugar and fat, to help tackle the is­sue. “The only thing use­ful for liver health with any clin­i­cal ev­i­dence be­hind it is drink­ing cof­fee,” he says. It’s not fully un­der­stood how cof­fee ben­e­fits the liver, though a 2016 re­port from the British Liver Trust found that con­sump­tion may pre­vent the can­cer, while five cups a day could po­ten­tially cut the risk of liver dis­ease by 80 per cent. “It’s cru­cial to re­mem­ber that much liver dam­age is rev­ersible,” says Fal­low­field. “When peo­ple lose be­tween seven and 10 per cent body weight through di­et­ing or weight-re­duc­tion surgery, NASH re­solves dra­mat­i­cally. It’s never too late.”

GETTY IMAGES/IS­TOCK­PHOTO

Ac­cord­ing to a 2016 re­port from the British Liver Trust, reg­u­larly drink­ing mod­er­ate amounts of cof­fee may pre­vent liver can­cer in some peo­ple, though it’s not clear why this works.

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