NON-ALCOHOLIC FATTY LIVER DISEASE

NON-ALCOHOLIC FATTY LIVER DISEASE

Context:

India has become the first country to act on non-alcoholic fatty liver disease

The Union Health Ministry has operationalized guidelines to integrate Non-Alcoholic Fatty Liver Disease (NAFLD) into the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), a step towards addressing the country’s non- communicable diseases (NCDs)

Concept:

• India has become the first country to do so and it will help in controlling the epidemic of NAFLD/Non Alcoholic SteatoHepatitis (NASH). This will bring in a sense of urgency in addressing the silent epidemic of NAFLD and NASH in India
• NAFLD, though a non-communicable disease (NCD), is an independent predictor of future risk of cardiovascular disease, Type 2 diabetes and other metabolic syndromes such as hypertension, abdominal obesity, dyslipidaemia, glucose intolerance. The operational guidelines help align existing NCD programme strategies to achieve the objectives of prevention and control of NAFLD. We see a greater integration and convergence in the approaches as the focus will be on prevention, early diagnosis and management of NAFLD with lifestyle changes and medication
• AFLD is a condition where the liver has fat accumulation and could lead to NASH a progressive disease of the liver. This could progress to cirrhosis and liver failure. It is a large unmet medical need. There is currently no approved drug for the treatment of NASH anywhere in the world. India’s NASH prevalence is estimated at 25 per cent of the population and ranks as a major cause of cirrhosis, hepatitis C and alcoholic liver disease.
• Liver transplant is the only option for managing advanced cirrhosis with liver failure. Rising cases of obesity due to sedentary lifestyle is an equally alarming issue. About 3-15 per cent of the obese patients with NASH progress to cirrhosis and about 4-27 per cent of NASH with cirrhosis patients transform to HCC (Hepatocellular Carcinoma). An alarming rise in metabolic diseases, in the developing and developed world, is expected to result in NAFLD/NASH-HCC, posing a serious health threat in future.

PREVENTION

Preventive health interventions are important as they help address the symptoms early on. Preventive tests not only help in timely action, but can also reduce the disease burden for families. Lifestyle modification, including significant weight loss through hypocaloric diet and exercise, is considered as a first-line intervention for the treatment of NAFLD. Besides the focus on yoga and wellness sessions at the community level, the focus of ‘Eat Right India’ and ‘Fit India Movement’, can also address NAFLD in its initial stages 

• National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched in 2010 in 100 districts across 21 States, in order to prevent and control the major NCDs.
• The main focus of the programme is on health promotion, early diagnosis, management and referral of cases, besides strengthening the infrastructure and capacity building.

Main strategies of the programme:

• Health promotion through behavior change with involvement of community, civil society, community-based organizations, media etc.
• Outreach Camps are envisaged for opportunistic screening at all levels in the health care delivery system from sub-centre and above for early detection of diabetes, hypertension and common cancers.
• Management of chronic Non-Communicable diseases, especially Cancer, Diabetes, CVDs and Stroke through early diagnosis, treatment and follow up through setting up of NCD clinics.
• Build capacity at various levels of health care for prevention, early diagnosis, treatment, IEC/BCC, operational research and rehabilitation.
• Provide support for diagnosis and cost-effective treatment at primary, secondary and tertiary levels of health care.
• Provide support for development of database of NCDs through a robust Surveillance System and to monitor NCD morbidity, mortality and risk factors.

Funding:

• The funds are being provided to States under NCD Flexi-Pool through State PIPs of respective States/UTs, with the Centre to State share in ratio of 60:40 (except for North-Eastern and Hilly States, where the share is 90:10).

NCDs:

• No communicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behaviours factors.
• The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.

Eat Right Movement:

• FSSAI has embarked on a large-scale effort to transform the country’s food systemin order to ensure safe, healthy and sustainable food for all Indians through the ‘Eat Right India’ movement.
• The tagline ‘Behtar Jeevan’, thus, forms the foundation of this movement.
• Eat Right India adopts a judicious mix of regulatory, capacity building, collaborative and empowerment approaches to ensure that our food is good both for the people and the planet.
• Further, it builds on the collective action of all stakeholders– the government, food businesses, civil society organizations, experts and professionals, development agencies and citizens at large.
• Eat Right India adopts an integrative or ‘whole of the government’ approach since the movement brings together food-related mandates of the agriculture, health, environment and other ministries.
• Furthermore, since foodborne illnesses and various diet-related diseases cut across all age groups and all sections of the society it also adopts a ‘whole of society’ approach, bringing all stakeholders together on a common platform.
• Eat Right India is aligned to the National Health Policy 2017 with its focus on preventive and promotive healthcare and flagship programmes like Ayushman Bharat, POSHAN Abhiyaan, Anemia Mukt Bharat and Swacch Bharat Mission.