More awareness needed on liver diseases: Internist

Mariecar Jara-Puyod, Senior Reporter

An Emirati Internal Medicine consultant called for more liver health and diseases discussions and more importantly, strategies for implementation, as a policy document on this issue was made available to the public on Sunday.

Specifically, Dr Farhana Bin Lootah of the Imperial College of London Diabetes Centre (ICLDC) in Abu Dhabi, among the 11-man Steering Committee behind the “Creating a Policy Narrative around NASH in Europe and the Middle East,” said policy makers should seriously consider steps against Non-Alcoholic Fatty Liver Disease (NAFLD) that may worsen to become Non-Alcoholic Steatohepatitis.

According to the 27-page document accessed through The Health Policy Partnerships’s website, NAFLD is a “chronic progressive liver disease strongly linked to obesity and which affects one in four people worldwide.”

NASH, in which the “liver is not just fatty but inflamed,” has a “significant public health impact (because) it can lead to liver cirrhosis and liver cancer, and is also both a consequence of and risk factor for chronic diseases related to obesity, such as Type 2 diabetes, cardiovascular disease, cancer and chronic kidney disease.”

Lootah said: “We know the prevalence of NASH is rising parallel to obesity and Type 2 diabetes. This is a real problem in areas where these conditions are prevalent, such as in the Middle East.”

“We need to integrate NASH into existing policies and initiatives aimed at preventing and reducing obesity, especially among children and young people,” she added.

To stress her point, Lootah cited a recent research on the NAFLD prevalence in the UAE and Saudi Arabia which had estimated that by 2030, the UAE would be dealing with approximately 372,000 NAFLD incidents “and cases of compensated cirrhosis and advanced liver disease were projected to at least double in the same period.”

Meanwhile, following are some of the highlights of the “The Childhood Obesity in the GCC Report” of the Ipsos Ethnography Centre of Excellence in the Middle East and North Africa published in January 2019.

The authors particularly probed on the UAE and Saudi Arabia, with the hope of “offering insights relevant to both manufacturers and policymakers”:

* Many parents understand their children are “overweight” but do not necessarily see them as being “unhealthy.”

* Junk food is often used as a reward for good behaviour/achievements, or for eating healthy food.

* Fathers who work long hours gift their children with sweets to show their affection which defeats any healthy lifestyle approach by the mothers.

* Some families do not perceive some traditional food as unhealthy.

* Digital technology and the harsh climate have led to sedentary lifestyle.

On the NAFLD/NASH policy document, Lootah and her co-researchers recorded the following:

* 25 per cent or 1.9 billion of the 7.7 billion global population have NAFLD.

* 20 per cent or 3.9 million of the 1.9 billion with NAFLD will develop NASH.

* People with NASH can progress to liver fibrosis (large amount of scarred tissue) stage 3 and cirrhosis.

* Two to 12 per cent or 78,000 to 468,000 of the 3.9 million with NASH will develop liver cancer per year.

They said NAFLD and NASH have been difficult to detect until it has progressed into liver cirrhosis or cancer. Reliable, non-invasive diagnostics tests as well as effective treatment options to improve patient outcomes are crucial.

They wrote: “Sustained weight loss is highly beneficial for NASH and its complications, and also addresses associated co-morbidities such as Type 2 diabetes; however, many people find it difficult to make and sustain the necessary lifestyle changes.”

Among their proposals is the inclusion of liver health and diseases in public health policies, programmes and strategies towards the mitigation and prevention of obesity among children and the youth.