Disease Baishali Nath  

NAFLD is part of operational guidelines now

Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of disorders ranging from the simple fatty liver to non-alcoholic steatohepatitis, increasing fibrosis leading to cirrhosis. Different scientific societies from Europe, America, and Asia-Pacific regions have proposed guidelines based on NAFLD’s most recent evidence. These guidelines are consistent with NAFLD management’s critical elements but still show a significant difference in some crucial points. With the increasing burden of non-communicable diseases now to tackle the NAFLD, India also launched the operational guidelines for integrating NAFLD with NPDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke).

The NAFLD is the condition when the abnormal accumulation of fat in the liver. It is independent of secondary causes of fatty liver, like excessive alcohol intake, viral hepatitis, or medications, is a serious health concern as it encompasses a spectrum of liver abnormalities, from a simple non-alcoholic fatty liver (NAFL, simple fatty liver disease) to more advanced ones like non-alcoholic steatohepatitis (NASH), cirrhosis and even liver cancer.

Globally, NASH caused more than 40 lakh prevalent cases of compensated cirrhosis in 1990, which increased to 94 lakh cases in 2017. NASH burden almost doubled over the last two decades. Epidemiological studies suggest that the prevalence of NAFLD ranges from 9 to 32% of India’s general population, and the highest prevalence was found in overweight or obesity and those with diabetes or prediabetes. Scientists have found NAFLD in 40 to 80% of people who have type 2 diabetes and 30 to 90% of people who are obese.

As people are adapting to a more sedentary lifestyle nowadays, people are more prone to obesity. About 3 to 15% of the obese patients with NASH progress to cirrhosis, and about 4 to 7% of NASH with cirrhosis patients transform to Hepatocellular Carcinoma (HCC). For the management of advanced cirrhosis and liver failure, a liver transplant is the last option.
Along with the focus of ‘Eat Right India’ and ‘Fit India Movement’, the government’s entire vision is to move from Diagnostic Cure to Preventive Health. An alarming rise in metabolic diseases in the developing and developed world is expected to result in NAFLD/NASH-HCC posing a severe health threat in future.

Saroglitazar has been approved for the treatment of both NAFLD and NASH in India. It was launched in India in September 2013 for the treatment of diabetic lipid diseases in patients with type-2 diabetes not controlled by statins alone. Its unique mechanism of action enables it to regulate both insulin & lipid metabolism.

Ayushman Bharat- Health and Wellness Centres (AB-HWCs) are playing a significant role in curbing NCDs. Ayushman Bharat programme has so far screened 838.39 lakh people, for hypertension, 683.34 lakh for diabetes and 806.4 lakh.

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