Fatty Liver Disease in Pakistan: An Underestimated Threat
Vol. 29, Issue 3 (September 2024)
Talal Khurshid Bhatti, MD
Fellow Gastroenterology
Shaheed Zulfiqar Ali Bhutto Medical University.
Islamabad, Pakistan
Lubna Kamani, MD, FCPS, MRCP(UK), FRCP(London)
President Pak GI & Liver Disease Society (PGLDS)
Professor of Gastroenterology, Director GI Residency Program, Liaquat National Hospital
Consultant Aga Khan University Hospital
Karachi, Pakistan
Nonalcoholic fatty liver disease (NAFLD) can vary from simple steatosis to nonalcoholic steatohepatitis (NASH) and has an increasing trend in the world as well as in Asia.1, 2 These pathological processes can lead to development of cirrhosis and/or hepatocellular carcinoma (HCC) and are linked with several systemic disorders including colorectal cancer, cardiovascular and metabolic conditions.3 Based on limited data, it seems that about 5-20% people in Asia may have NAFLD, but it is multifactorial and based on location, gender, race and age.4 An absence of symptom and health alarm in the majority of patients with NAFLD makes its diagnosis and management more challenging.1, 5 The term metabolic dysfunction-associated steatotic liver disease(MASLD), originates from its predecessor, non-alcoholic fatty liver disease(NAFLD).6
In a recent study conducted by Ghani et. al, NAFLD definition was used to investigate metabolic risk factors associated with this condition in Pakistani population.7 The study concluded that an overall prevalence of NAFLD was 14.8% higher among individuals aged 40 years and above (19.9%).7
Additionally, Pakistan is among the top three countries in type 2 diabetes mellitus prevalence and according to estimates, 26.7% population which estimates 33 million people are currently living with this disease.8 Moreover every one in four individuals living in Pakistan are suffering from obesity.9 This data is alarming and it is of utmost importance to implement both public and individual strategies against MASLD in Pakistan. The consequences of MASLD are vast and significantly impact public health and the health care system.10
MASLD not only increases the risk, but also enhances the pathophysiology of DM, cardiovascular diseases and CKD. Preventing MASLD and its associated complications urges comprehensive policy changes that includes public health initiatives and necessary educational measures. Multiple strategies can be implemented to combat the disease impact, including but not limited to, public health awareness, school based interventions, improved facilities and effective implementation of public health policies. It is extremely important to increase public health awareness. Firstly, it is vital to increase public awareness about MASLD’s possible risk factors, preventive strategies, signs, and consequences. Educational campaigns focused on wider health initiatives, involvement of health care professionals and local stake holders of community can be effective communication tools. Moreover, promoting healthy lifestyle habits, like a balanced diet and regular exercise, is essential in alleviating the strain of cardiometabolic disorders and MASLD. Secondly, the establishment of educational programs in schools should be focused towards encouraging healthy habits, encouraging physical activity, and offering nutritious meals to children.
This approach directly addresses the rising issue of childhood obesity, which is also of much concern. Thirdly, an inclusive healthcare strategy is essential to holistically manage MASLD. This requires the fortification of primary healthcare services to ensure early detection, diagnosis, and treatment of cardiometabolic disorders. Healthcare professionals should undergo training in the identification and management of MASLD. The creation of specialized clinics is necessary to provide comprehensive care along with need of upgrading existing health care facilities, which is an uphill task in a resource-limited country like Pakistan. Encouraging a collaborative environment among healthcare professionals, researchers, and policymakers is crucial.
In summary it has become inevitable that we take necessary measures to prevent the spread of MASLD and prevent it from developing into an epidemic. Public awareness campaigns and thoughtful collaboration of relevant stake holders can effectively layout successful public health policies, which will have an everlasting impact on health and the well-being of the Pakistani population.
References
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2. Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H, et al. Changes in the Prevalence of the Most Common Causes of Chronic Liver Diseases in the United States From 1988 to 2008. Clinical Gastroenterology and Hepatology. 2011 Jun 1;9(6):524-530.e1.
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7. Ghani RA, Saqlain M, Zafar MM, Jabeen S, Naqvi SMS, Raja GK. Identification of Metabolic risk phenotypes predisposing to Non-Alcoholic Fatty Liver Disease in a Pakistani Cohort. Pak J Med Sci [Internet]. 2017 Jan 1 [cited 2024 Apr 19];33(1):121. Available from: /pmc/articles/PMC5368291/
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