FATTY LIVER

Internal Medicine

Fatty liver awmzia chu kan thin (liver) ah thau a tam tihna mai a ni. A chhan tam tak a awm ang e.g.

1. Zu in tam

2. Hepatitis C

3. Hapatitis B

4. Obesity (thau vang)

Kan ziah tum ber chu NAFLD (Non Alcoholic Fatty Liver Disease) a ni.

Tun hma chuan ultrasound report nen damlo an lo kal a, “ka pu fatty liver i nei min ti a, engtin nge ni ang?” tiin damlo in min zawt ṭhin. Kan chhanna tlangpui chu “Thil mawm/sa thau insum rawh” kan lo ti mai ṭhin. Tunah chuan natna inkaichhawn theih loh mahse khirhkhan ve si a ni tih hmuhchhuah a ni tawh a, khawvel mithiamte ngaih pawimawh pawh a hlawh ta hle a ni.

Definition (mak kan ti mai thei)

Non alcoholic fatty liver disease chu, zu in tam si lova, thin a thau tam tihna a ni - mipa leh hmeichhiaah a awm ve ve thei.

Zu, in tam tih chin hi ram hrang hrangah concensus a awm chiah lova, mahse India a kan pawm chu 20 grms/ day (approximately 30 mls of whisky = 100 mls of wine = 240 ml of beer = 10 g of alcohol. USA leh Europe-ah chuan hmeichhe tan nitin peg 1 aia tam. Mipa tan nitin peg 2 ai tam hi a hlauhawm (significant) chin nia ngaih a ni.

A awmzia chu a chunga kan tarlan figure chin aia tam lo in chuan thin a khawih chhe tam lo a ngaih a ni.

Risk factors for NAFLD

Common deuhte

1. Obesity (thau lutuk)

2. Type 2 Diabetes mellitus

3. Dyslipidedia (thau chhia sang)

4. MetS (Metabolic Syndrome)

5. Polycystic ovary Syndrome

6. A pawimawh ber chu Obesity (thau lutuk) a ni a, mahse a 'fun' kim ber tur Metabolic Syndrome (MetS) kan thlur bing ang. Mizo zingah pawh kan lo tamzia kan hre chhuak ngei ang. Metabolic Syndrome hi Dr. Herman Haller-an 1950 a a phuah a ni.

Metabolic Syndrome chu eng nge ni?
1. Central obesity (dul kiar)
2. Diabetes Mellitus (zun thlum) Fasting Blood Sugar->126mg%
3. Hypertension (BP sang)
4. Low HDL (thau tha) <40 (mipa tan) 0<50 (hmeichhe tan)
5. High Triglycerides >150 mg %
Heng zinga mi pathum kan neih chuan metabolic syndrome kan nei tihna a ni.
Obesity tehna (body mass Index) hi hman lar ber a ni a.
Normal = BMI – 18 – 22.0 kg/m2 Over weight – BMI – 23 – 24.9 kg/m2 Obesity–BMI–.25 kg/m2 aia sang
Mahse India ramah chuan BMI hmanga thau (Obese) si lo dul kiar (abdominal obesity) kan tam em avangin waist circumference (kawng len zawng) teh tel tur a ni.
• Mipa tan ≥ 90 cm a thau
• Hmeichhe tan ≥ 80 cm a thau
NAFLD hi liver (thin) Metabolic Syndrome-in a effect (nghawng) aṭanga lo awm a ni. WHO thuchhuak (statement) kan belh leh lawk ang.
• 1975 aṭanga 2016 chhungin khawvelah Obese a let thum ngawtin an pung
• 1.9 billion zet puitling (kum 18 chung) kan over weight, heng zinga 650 millions aia tam chu (obese) thau kan ni.
• Kum 18 chung lamah 39% zet chu khawvel pum puiah kan over weight, hmeichhiaah an tam zawk.
• Khawvel mihring zawng zawng 13% chu obese kan ni. Hmeichhia an tam leh zawk.
• Kum 5-19 inkarah obesity pawh 1975 ah 4% chauh a nih lain 2016 ah chuan 18% in a pung.
A chunga mi kan ziah deuh duah chhan chu thau kan pung a, chumi awmzia chu – a hnuaia natnate hi a pung.
1. Zunthlum
2. Thisen sang
3. NAFLD
4. Gout
5. Heart attack
6. Stroke etc.

Metabolic syndrome leh NAFLD inzawm dan
Metabolic syndrome leh NAFLD hian inang deuhin – Diabetes, Hypertriglyceridemia leh obesity hi an inṭawm (nei kawp) duh em em a ni. A awmzia chu NAFLD hi thin (liver) in Metabolic syndrome a vei (manifestation) dan a ni. NAFLD nei zinga 90 % ten Metabolic syndrome in a ken tel natna pahnih khat tal nei anga ngaih a ni a, NAFLD nei zing a 33.0 % ten Metabolic syndrome an nei. NAFLD nei zing a 29-58 % ten zunthlum (Diabetes) an vei anga chhut a ni a, 27-92% ten dyslipidemia thau chhia an nei bawk. NAFLD nei tam takin thisen sang an nei tel bawk.
Thau, zunthlum nei, thau chhe ngahah NAFLD hi a common hle a, kum tam lamah nei an tam zawk a, mipaah a let hnihin a common zawk bawk.

FATTY LIVER AH LUT TAWH ILA-
Kan thin/Liver hi kan taksa kudam (go-down) ang a ni a. Kan taksa mamawh hrang hrang lo siamtu leh lo khawltu a ni. Kan taksa peng hrang hrangin a mamawh e.g. glucose, protein, sugar etc. te kan ei leh in aṭangin a lo khawl a, kan mamawh hunah chemical reaction hmangin a pe chhuak ṭhin a ni.
Fatty liver chu kan thinin a khawl leh a pekchhuah theih aia tam thau kan eia lo insiam tih kan chiang mai awm e.
Fatty liver NAFLD kan nei ta a, engtin nge ni zel..
1. NAFLD ringawt kan nei a nih chuan thin natna serious kan la nei lo a, fatty liver kan tih kha kan pai a ni mai.
2. Kan insum a, kan taksa kan sawi zawi ṭhat a, kan ei leh in kan inuluk a, kan fimkhur thiam chuan 60 % chu a normal leh thei a ni.
3. Kan insum loh a, exercise te kan la a, kan rihnate kan paih loh chuan 25 % chu NASH (Non alcoholic SteatoHepatitis) ah a tlangpuiin kum thum (3) chhungin a chang ṭhin. A awmzia chu Hepatitis stage-ah a lut tihna a ni. NASH kan neih tawh chuan amahin a normal leh thei tawh lo.
4. Damdawi te kan ei a, kan insum loh chuan NASH kan neih aṭanga kum 1-7 ah chuan Fibrosis kan thinah a lo awm a, chu chu Cirrhosis (thinro) stage-ah kan awm tawh tihna a ni. Cirrhosis stage hran hran a awm a, damdawi kan ei a, kan life style (ei leh in, exercise) kan thlak bawk chuan cirrhosis pawh a progress chak lo thei a ni. Thin cancer hi, thin ro cirrhosis neih hnu hian a awm tlangpui. Mahse NAFLD leh hepatitis ‘B’ ah chuan Cirrhosis neih hmain thin cancer a awm direct thei. NAFLD hi thin cancer chhan pathumna a ni a, NAFLD hi Liver Transplant ah a common pahnihna a hepatitis dawt a hauh a, tun aṭanga hun rei lo teah chuan pakhatna a nih rin a ni.
Eng tin nge kan hriat ang /diagnose ang tih kan ziah hmain hriat tur pawimawh em em ṭhenkhat tarlang phawt ila.
• Kan thau kungin kan inhre lo mai thei, mahse kan dul a kiar a nih chuan NAFLD kan neihna chance a sang em em a ni. Chuvangin Waist circumference (kawng lenzawng) hi kan ngai pawimawh em em tur a ni.
• NAFLD ringawt ni lovin, zunthlum, thisen sang, thauchhe tam (dyslipidemia) gout te nen a inzawm (neih kawp) tam em em.
• Zunthlum, thisen sang i neih a, i thau a, I dul a kiar bawk a nih chuan natna dang ka nei em? tih doctor te rawn a ṭha.

DAMLO EXAMPLE PAKHAT CHIAH
Pi X-i, kum 60, casualty ah nikhaw hre lovin an rawn hruai a, ka en a, a chhan ka zawng a, zunthlum nei ṭhin an tih avangin sugar a hniamin emaw a sang emaw a niang tiin ka check-tir a, a normal. CT Scan kan ti a, a normal, mahse a thisen kan test result dang a chhuah chuan a report ah Cirhosis a nei tih kan hmuchhuak a, Hepatic Encephalopathy kan tih Thinro (Cirrhosis) vanga nikhaw hre lo tih kan diagnose ta a ni. Treatment kan pe a, a harhchhuak leh mai a, mahse vanduaithlak takin thin cancer a lo nei hman tawh reng bawk.
A awmzia chu zunthlum a nei, a zunthlum ngawr ngawr treatment a la a, eng nge natna dang (na si lo) metabolic syndrome kan sawi tak kha a lo nei tel a, NAFLD aṭangin NASH →Cirrhosis →Hepatic Encephalopathy → thin cancer (Haepato cellular carcinoma) a lo nei der a nih chu. A vanduai hlein a pawi vawng vawng.

A diagnosis (Hriat chhuah) dan
• A hma lama ka ziah Metabolic Syndrome kan neih chuan, thisen sang, zunthlum, gout kan nei emaw, nei lo emaw NAFLD ka nei tel thei tih inrinhlelh ngei ngei tur a ni.
• NAFLD hriat chhuah nana khawvelin ṭha ber (gold standard)-a a pawm chu Liver Biopsy a ni.
• Mahse a na a, complication a tam avangin test hrang hrang hmangin a hriat theih a, Biopsy chu NASH leh cirrhosis stage hriat nan hman a ni ber tawh.

A HNUAIA KAN ZIAH HI TEST COMMON (NON-INVASIVE) TE CHU A NI.
1. Ultrasound
2. MRI
3. Fibroscan
4. Liver Function Test
5. Lipid Profile
6. Natna dang kan neih kawp dan azirin test chi hrang hrang pawh a ngaih chang a awm.

KHAWVEL RAM HRANG HRANGA NAFLD DINHMUN
1. India - 9-35 %
2. Africa - 13 %
3. Asia - 27 %
4. Europe - 24 %
5. Middle East - 32 %
6. N. America - 24 %
7. S America - 30 %

TREATMENT/ENKAWL DAN
1. Damdawi chi hrang hrang a ṭha tih a awm a, mahse mahni thu a lei a, ei ngawt a him ber lo. Natna dang nen a inkaihhnawih fo kan tih kha, chung natnate kan nei tel em tih hriat fel hnuah chauh damdawi thlan tur bik a awm a, Doctor rawn lo chuan ei ngawt a him lo.
2. Life style modification/weight deductions. Nunphung thlak, rihna tihhniam.
Hei hi a pawimawh ber a ni. Exercise ho te – morning walk/ jogging – 45 minutes kar khatah ninga tal lak ṭhin a ṭha.

Reference :-
1. Non-alcoholic Fatty Liver Disease and Metabolic Syndrome – Position Paper of the Indian national Association for the Study of the Liver, Endocrine Society of India, Indian College of Cardiology and Indian Society of Gastroenterology
Journal of Clinical and Experimental Hepatology
2. The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance From the American Association for the Study of Liver Diseases Hepatology AASLD

- Dr. H. Lalrinmawia MD(PGI)