Obesity in the region increases risks of liver diseases

By Cheranka Mendis

Known as a silent disease, the risks for liver diseases within the region is under the threat of increasing if people do not go for early screening and adopt preventive methods at an early stage.

Gleneagles Hospital Gastroenterologist Dr. Vincent Lai, in Sri Lanka to attend a lifestyle seminar on ‘What you should know about the liver’, told the Daily FT prior to his lecture that the most common in the factor for liver diseases in the region is viral hepatitis, alcoholic diseases and fatty livers which is becoming the next big epidemic.

“Everyone is getting fatter across the globe,” Lai said. “Even in Singapore 30% of the population is overweight. In China, because of the single child syndrome, children are treated like kings, pushing up their obesity rate. If you look at Western society, the obesity rate is again high. At the moment the common reason for liver diseases in developed countries is Hepatitis C. The next epidemic for liver diseases will be caused by metabolic from fatty livers.”

Even though in most cases, the patients are too late by the time they come for treatment, there are methods of prevention, he expressed. “Most medical conditions can be prevented to a certain level. If you detect early, most liver conditions can be reversed. And it is very simple. Patients should do a liver function test and screen for common things like viral hepatitis.”

Most countries have now adopted universal vaccination for Hepatitis B. In Singapore pre 1987, the rate for Hepatitis was 10%, one in 10 people born before 1987 had the virus. Following that, everyone was vaccinated so the rate has now dropped to 3%. “If a patient is overweight or diabetic (fatty liver associated) they should be tested.”

Lai noted that unfortunately in most cases patients come only when they are quite ill, either with liver failure or unfortunately with quite advance cancer. “We are here to create awareness on liver diseases and the most important thing, to screen for it. If you catch the liver disease early enough you can more or less stop it or reverse it. Unfortunately for some by the time they come to us there is liver failure or if they have a tumour, the only option available at that time is liver transplantation.”

ParkwayHealth, a leading provider of private healthcare with hospitals and medical centres in Singapore, Brunei, China, India and Malaysia under which Gleneagles Hospital falls under conducts successful liver transplantation, he said. Located in Singapore, the transplantation rate is much high, he said. “There are couple of differences in doing it in Singapore. The main one is that the Blood Bank there is extremely safe.”

In comparison to regional transplant they also allow emotionally related transplantation i.e. one doesn’t not have to be related to the patient so long as they are emotionally connected.

“Our program has been ongoing for a number of years. The data published shows that it is comparable to international standards.” He also noted that most of the health care standards in the surrounding regions are improving and that a lot of programs are starting up in countries which includes in Sri Lanka.

“Like all things once you start a program there is always a learning curve. If you look at all units across the world and when they look at transplant results they break it down every five years. Every five years there will be a marked improvement in their results for the first ten years. After the first 10 to 15 years then it becomes stable.”

Lai also acknowledged that the predominant difference between South Asia compared to other regions is that most of the transplants are done through the support of living donors. In the European and American societies most of the transplants are taken after death, which is known as cadaveric transplants.

Unfortunately liver donation in the region is very low for cadaveric transplants. “Here we are looking at a about five for a million population. The highest is the Spanish which has a 40 for a million populations. So we have no choice.” Out of necessity in Asia a living- donor program was developed.

Lai commented that the only reason this could be done was because the liver is a remarkable organ which has the ability to regenerate. “It has been known since 18th Century that the liver will regenerate. As a result, living donation rate within the region is very high.”

In donating livers one must ensure that the bones are healthy so that even the simplest of operations poses no risk. “The biggest problem of living donors is that there is a small risk of healthy bones,” he commented. “However a lot of lives have been saved as a result of living donor transplants.” In the western society, although there cadaveric donation rate is high it can never meet the demand. There are always people dying. “Following that they are now looking into living donor programs as well,” Lai said.

Speaking about Sri Lanka, he noted that he has been made to understand that the program is at its initial steps. “As far as I know the program is just starting in Sri Lanka and as most things, you need to coach in surgeons, haematologists and many others. In our programs in Singapore there are more than 15 doctors attending a single transplant.”

He added that he is confident that the country could proceed with successful implementation with the right guidance and skill development of the local medical force.