FATTY LIVER and the Heart

“Fatty Liver” that commonly finds mention in an ultrasound examination report and is often passed off as an incidental finding, may not be innocuous after all, suggest recent studies in reputed medical journals.  Japanese and European scientists have noted a four-fold increase in risk of heart disease in these patients compared to those of the same age and sex who had normal livers.

Using sophisticated techniques, doctors have found the wall of arteries to be thicker and the lumen narrower, causing reduced flow of blood to their heart muscles and brains, in these patients. Their findings support the clinical observation that those with excess fat in their livers are more vulnerable and die earlier from heart problems.

The appearance of a “bright” and swollen liver suggesting excess fat deposition is a common finding on ultrasound examination. While it is commonly seen in drinkers, it is often seen in tee-totallers too, and is referred to as non-alcoholic fatty liver disease or NAFLD in them. Although the risk of liver damage due to this fat is modest and occurs in only 20% when present for over 20 years, proneness to heart attacks is grossly increased.

NAFLD is usually associated with obesity, diabetes, hypertension or high amounts of circulating fats in the blood, and is often called a “Life Style Disorder”. Lack of adequate exercise and consumption of excess calories have been shown to lead to obesity and excess fat deposits in the liver.

The mechanism underlying this disorder called Insulin Reistance, is similar to that which occurs in diabetics of the Type 2 variety or the common adult type, in which patients have high circulating levels of Insulin that prove ineffective in driving sugar into cells. Insulin Resistance also causes excess accumulation of fat in liver cells, as well as thickening of arteries that cause heart or brain disease.

Regular excercise and reduction of weight form the fulcrum of treatment of this disorder. Apart from helping reduce weight, aerobic excercise up-regulates a protein (glut-4) that restores the sensitivity of cells to circulating insulin. Hence insulin and sugar levels both come down, fat gets mobilized from the liver, buttocks and abdomen, and the increased risk of heart disease is restored to normal levels.

India is in the eye of an emerging global epidemic of diabetes and heart disease. While our genes may be partly accountable for our misfortune, the greater share of blame lies in our reluctance to exercise regularly. While vagaries of weather and unsafe roads may come as handy excuses, we Indians, more than any other race, need to shake off our laziness and indulge ourselves in far more and regular exercise than what we are doing at present.  And we need to start quite urgently if we need to live longer and healthier lives.

As published in HT City ( Hindustan Times) dated 6 March, 2011.