In response to the rising incidence of Non-Alcoholic Fatty Liver Disease (NAFLD) across India, Himachal Pradesh has initiated a dedicated awareness and training programme aimed at educating healthcare professionals and the general public about the disease.
A one-day Training of Trainers (ToT) session was recently conducted by the National Health Mission at the State Institute of Health and Family Welfare, Shimla. The event brought together medical professionals from various hospitals across the state, equipping them with essential knowledge on NAFLD, including its causes, detection, and prevention strategies.
These trained professionals are expected to further disseminate this information to doctors serving in different parts of the state, ultimately reaching the wider population.
The Growing Burden of NAFLD
Dr. Kanica Kaushal, Associate Professor in the Department of Clinical Research and Epidemiology at the Institute of Liver and Biliary Sciences (ILBS), New Delhi, delivered an insightful presentation titled “Fatty Liver Reduction is Core to All NCDs.”
She elaborated on the Operational Guidelines for Non-Alcoholic Fatty Liver Disease under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) and discussed the integration of NAFLD management into India’s broader NCD framework.
Dr. Kaushal highlighted the alarming prevalence of NAFLD, calling it the most common chronic liver disease worldwide, affecting up to one-third of the global adult population. In India, the estimated prevalence ranges from 9% to 53%, with the country contributing to 20% of liver disease-related deaths globally. She further emphasised that one in three Indians is affected by fatty liver, making it a significant public health challenge.
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Link Between NAFLD and Other Diseases
Dr. Kaushal explained that NAFLD is closely linked to metabolic disorders, including obesity, type 2 diabetes mellitus, dyslipidemia, hypertension, coronary artery disease, metabolic syndrome, and even certain cancers. She pointed out that NAFLD often precedes these conditions and has a bi-directional relationship with them.
Due to its increasing prevalence and potential to progress to severe liver complications such as cirrhosis and hepatocellular carcinoma, NAFLD has been recognized as a priority area requiring robust primary care interventions.
“The revised operational guidelines for NAFLD provide updated strategies for preventing and managing the disease within the framework of the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD),” she noted.
Understanding NAFLD and Its Progression
NAFLD is a condition characterised by the excessive accumulation of fat in liver cells, which is not caused by significant alcohol consumption. While a small amount of fat in the liver is normal, when fat comprises more than 5% of the liver’s weight, it leads to fatty liver (steatosis).
The disease spectrum ranges from simple fatty liver (NAFL or simple steatosis) to a more severe form known as non-alcoholic steatohepatitis (NASH). NAFL involves hepatic steatosis without significant inflammation, whereas NASH is characterized by hepatic steatosis with inflammation, which can lead to fibrosis, cirrhosis, and even liver cancer.
Dr. Kaushal underscored that NAFLD is strongly associated with the growing prevalence of obesity and metabolic syndrome. Sedentary lifestyles and unhealthy dietary patterns have contributed to its rise, particularly in developing countries. Notably, cardiovascular disease is the leading cause of mortality in patients with NAFLD, further linking the disease with other non-communicable conditions.
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NAFLD and Its Economic Impact
One of Dr. Kaushal’s research articles, “Non-Alcoholic Fatty Liver Disease Integration into India’s NCD Programme: Obstacles and Solutions,” published in the Journal of Family Medicine and Primary Care, highlighted the significant economic burden of NAFLD. The study pointed out that individuals with NAFLD are at high risk of developing metabolic comorbidities, placing an enormous strain on healthcare systems.
“If not managed in a timely manner, NAFLD can lead to sustained healthcare costs, economic losses, and a reduced quality of life,” the research emphasized.
Challenges in Implementation
While the Indian Ministry of Health and Family Welfare has recognized the need for a comprehensive approach to NAFLD prevention and control, integrating public health measures into the existing NP-NCD framework, Dr. Kaushal’s research revealed gaps in implementation.
Despite being integrated into the NP-NCD three years ago, there is no clear assessment of how extensively the program has been executed. Additionally, the facilitators and barriers to its effective implementation remain unidentified.
Experts emphasise the need for proactive policy implementation, greater awareness, and early intervention to curb the rising incidence of NAFLD. Strengthening primary healthcare services, promoting lifestyle modifications, and ensuring early screening can significantly reduce the burden of this silent but life-threatening disease.
With Himachal Pradesh taking a proactive step toward educating its medical community, it sets a precedent for other states to strengthen their efforts in combating NAFLD through robust awareness, prevention, and management strategies.
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