Words by Dr. Jose Sollano, M.D.

In the Philippines, a silent epidemic demands our attention—a growing health crisis known as Non-Alcoholic Fatty Liver Disease (NAFLD), also referred to as Fatty Liver Disease.

As a practicing gastroenterologist/hepatologist in the country for several years, I am alarmed at the increasing number of my patients suffering from fatty liver disease. Most of them are obese and also have other concomitant diseases such as diabetes mellitus, high blood pressure, and high levels of cholesterol and triglycerides. I believe that by sharing this observation with my colleagues, it will further raise awareness about the causative factors and the preventive measures we can take together to address NAFLD. I urge people to take control of their (good) health.

At its core, NAFLD is a disease characterized by an excessive accumulation of fat in the liver and is considered the most common liver disease worldwide, affecting an estimated 38 percent of the world’s population. The burden of liver diseases globally is enormous, with 1.5 billion people suffering from chronic liver disease (CLD) worldwide, encompassing the entire impact of COVID-19.

A study from the Philippines estimated that between 10 to 20 percent of Filipinos may have NAFLD. Since NAFLD may lead to liver cirrhosis and liver cancer, patients with fatty liver may constitute some of the 16,500 individuals who die from liver disease complications each year.

The alarming nature of Fatty Liver Disease lies in its potential to evolve quietly, transitioning from a seemingly benign simple fatty liver into a far more critical state known as Non-Alcoholic Steatohepatitis (NASH). NASH represents a significant turning point for patients with fatty liver, as it involves inflammation and damage to liver cells, which can ultimately lead to fibrosis, cirrhosis, and even liver cancer.

While the exact causes of the disease are complex and multifactorial, they often stem from a confluence of genetic predispositions, metabolic factors, and lifestyle choices. According to the 2019 research of the Department of Science and Technology (DOST) Food and Nutrition Research Institute (FNRI), 27 million Filipinos are overweight and obese, which is caused by people’s sedentary lifestyles and unhealthy diets. This significantly contributes to the rise of NAFLD in our country.

In addition to obesity, insulin resistance, and conditions like Type 2 diabetes and cardiovascular disease further amplify the risk, with diabetes affecting one in fourteen Filipino adults and cardiovascular disease affecting one in six. Fatty Liver Disease is not only one of the leading causes of Chronic Liver Disease (CLD) but is also emerging as the primary cause of liver cancer and cirrhosis.

NAFLD’s prevalence and potential consequences are a looming threat to public health and individual well-being, therefore it’s imperative to bring it to everyone’s attention once again and this time emphasize the urgency of this health crisis.

NAFLD is preventable, and prevention starts with awareness, understanding, and a commitment to these preventative measures.

Early detection is crucial in the prevention of fatty liver, but the country is suffering from the lack of standardized guidelines for its diagnosis and management. Intervention needs to be done at a stage when the disease can still be controlled and potentially reversed.

In the industry, detection typically involves the utilization of diagnostic tests such as Alanine Transaminase (ALT) testing, which quantifies the amount of liver enzymes in the bloodstream; biopsy, a procedure involving extraction of tissue or cellular samples for laboratory analysis; fibro scan, a type of liver elastography that measures liver stiffness and fatty changes in the liver; and ultrasound, an imaging test that uses sound waves to produce detailed images of organs and other structures within the body.

Of all these methods, ultrasound is the most accessible to most patients in the Philippines in terms of cost and availability. This is especially critical for patients with metabolic syndrome, and medical practitioners need to be more proactive in conducting these tests for the early detection and prevention of the disease.

For individuals identified in the early stages of NAFLD, hope exists for disease reversal, as the liver is an organ known for its regenerative capacity. The most effective method of achieving this reversal is through lifestyle modification in the form of diet and exercise, however, it is imperative to adopt a holistic approach, considering the patient’s psychological and emotional well-being, fostering a healthy and committed mental state. Moreover, healthcare professionals, who can serve as role models and provide steadfast support, play a pivotal role in reinforcing the efficacy of this treatment.

Early detection and treatment would not be possible if people are not aware and educated enough about NAFLD. Knowledge empowers individuals to make informed decisions about their lifestyles and seek timely medical attention, which is why raising public awareness and providing comprehensive education on fatty liver is paramount in reversing this silent epidemic.

The time to act is now. While fatty liver imposes many risks for the patient, it is easily preventable if diagnostic tests for detection are standardized and normalized for all. Through these concerted efforts, we can collectively work to safeguard our health, prevent the escalation of the disease into more severe conditions, and ensure a healthier future for all.

Sources:

https://globalliver.org/wp-content/uploads/2022/11/Global-State-of-Liver-Health-report.pdf https://www.journal-of-hepatology.eu/article/S0168-8278(23)00324-0/fulltext#:~:text=to%20enhance%20comparability.-,Introduction,38.0%25%20in%202016%2D2019. https://www.cghjournal.org/article/S1542-3565(19)30849-3/fulltext

https://www.unicef.org/philippines/press-releases/everybody-needs-act-curb-obesity

https://med.stanford.edu/content/dam/sm/care/PH-Data-Brief.pdf