Dual Offer + FREE Dr Advice | WhatsApp Prescription | Book Home Visit ✆ 09220145540

Menu Icon

Liver Disease - Lifestyle to Blame?

Liver Disease - Lifestyle to Blame?

Posted By HealthcareOnTime Team Posted on 2022-04-08

Liver- An Indispensable Organ
One of the largest organs in the body, the liver supports almost every other organ in the body. It consists of two lobes connected by the falciform ligament which anchors it to the diaphragm. It is a part of a complex processing system which ensures that all parts of the body receive energy and nutrients in sufficient amounts. It is also involved in both, the removal of waste produced by the body and in neutralizing the nutrients and drugs in our body.

Liver Disease - Lifestyle to Blame?

Among the functions performed by the liver are
1. Release of bile as a part of digestion of fats, cholesterol and absorption of some vitamins, like vitamin K
2. Removal of toxins, including alcohol, from the body
3. metabolism of bilirubin, which is produced from the breakdown of hemoglobin ; after breakdown of bilirubin, the iron is reused for synthesis of new blood cells
4. Carbohydrate metabolism, where stored carbohydrates are broken down in liver to glucose; regulation of blood glucose and cholesterol levels
5. Home to a high number of Kupffer cells which are involved in immunity
6. Synthesis of proteins like albumin and hormones like angiotensin

Liver Diseases
Liver diseases are rising as one of the major lifestyle disorders in our country, and it adversely affects the quality of life and also reducing life expectancy.

Hepatitis C
Hepatitis is the term used to describe inflammation of the liver. This condition may either resolve on its own, or it may progress into fibrosis, cirrhosis, or even liver liver cancer. It can arise from several factors like alcohol abuse, some drugs, autoimmune conditions and infections (caused by virus, bacteria, fungi and parasites). If caused by a virus, it is known as viral hepatitis. There are 5 types of viral hepatitis and each is caused by a different virus-Hepatitis A, B, C, D and E virus. Of these, HAV, HBV and HCV can cause acute disease showing symptoms like nausea, abdominal pain, fatigue, malaise, and jaundice. In certain cases, acute infection may also develop into chronic infection.

Hepatitis C is caused by the hepatitis C virus and can be acute or chronic hepatitis infection based on the severity and duration of the infection. Acute HCV infection is usually asymptomatic while chronic HCV infection is associated with a high risk of liver cirrhosis. Transmitted by infected blood, it is estimated that 71 million people globally are infected by HCV. Some cases of HCV infections resolve themselves, while some others develop into mild forms of the disease. In 60% of the cases, HCV infection develops into the chronic progressive form. This depends upon the balance of several factors such as effectiveness, specificity and rapidness of the immune response, and the replication rate of the virus.

The major complication of HCV infection is the development of fibrosis, which increases the morbidity and mortality in chronic hepatitis by causing cirrhosis or hepatocarcinoma which can lead to death. After invasion into a host, the virus multiplies in the bloodstream as well as various other tissues including the B and T lymphocytes. While the liver is the principal site of replication, the virus also infects other tissues like those of pancreas, thyroid, adrenal glands, spleen and bone marrow. HCV can also directly infect the lymphatic tissue and can even lead to the development of B cell lymphoma. Since HCV variants develop when the virus infects extrahepatic sites, immune recognition of the virus is also affected.

Alcoholic Liver Disease
Liver being the main site of alcohol metabolism, alcohol abuse leads to the development of alcoholic liver disease. The metabolism of alcohol by the liver is done in three ways, by the alcohol dehydrogenase, by cytochromes and by mitochondrial catalases. Of these, the first two enzymes convert alcohol to acetaldehyde which is partly responsible for the damage to liver. Aside from this, the oxidative damage is caused to the liver cells by simultaneous shortage of antioxidants in the liver cells and also by the alteration in the balance of many cytokines, mainly tumor necrosis factor-alpha. Changes in lipid metabolism and in adipose tissue can also promote injury to liver in alcoholic liver disease.

In chronic alcohol abusers, liver disease arises from chronic changes like steatohepatitis and fibrosis to development of cirrhosis later in life. Simple steatosis is reversible through abstinence for a few weeks. Steatohepatitis, while also reversible, is a fibrogenic process which induces changes that ultimately lead to cirrhosis. Although simple steatosis is a relatively benign condition, with chronic alcohol abuse, it can lead to the development of fibrosis and cirrhosis within 10 years. This progression also depends upon other environmental factors. Severe alcoholic hepatitis can have a death rate of up to 50%.

Non-alcoholic Fatty Liver Disease (NAFLD)
Non-alcoholic fatty liver disease is a common term that is used to describe the condition in which adipose tissue is deposited in the liver, and may sometimes manifest as progressive steatosis with associated hepatitis, fibrosis, cirrhosis, and can progress to hepatocellular carcinoma (HCC). NAFLD is characterized by steatosis of the liver without hepatocyte injury. Among the risk factors that can lead to the development of NAFLD are metabolic syndrome, type 2 diabetes mellitus, high-fat diet, both passive and active smoke exposure and reduced physical activity.

The accumulation of free fatty acids and Triglycerides is the hallmark of this condition and is partly attributable to insulin resistance and obesity. Two steps are proposed to be involved in the development of NAFLD. The first step involves hepatic lipid accumulation due to sedentary lifestyle, high-fat diet, obesity and insulin resistance. The second step is the activation of inflammation associated with fibrosis. Insulin resistance is believed to play a key role in the development of steatosis which leads to increased de novo lipogenesis and reduced lipolysis. This causes accumulation of fats in the liver, which further causes adipose tissue dysfunction through alterations in the production and secretion of cytokines, brought about by insulin resistance. Triglyceride deposition is also seen due to production of reactive oxygen species and mitochondrial dysfunction that is associated with endoplasmic reticulum stress.

Hepatocellular Carcinoma (HCC)
The most common primary malignancy of the liver, HCC is often seen in patients with chronic liver disease and cirrhosis. It is believed to originate from hepatic stem cells, and can progress with local expansion, intrahepatic spread, and distant metastasis. While cirrhosis is the most important risk factor for the development of HCC, inflammation, necrosis and fibrosis also contribute to development of HCC. Chronic infection with both hepatitis B and C are independent risk factors for HCC. When arising from HBV infection, HCC presents with underlying cirrhosis of the liver. Patients with HCV infection also show cirrhosis of the liver.

HCC mediates liver damage through the development of inflammation and fibrosis of the liver. In livers with cirrhosis, focal areas with abnormal immature hepatocytes are known as dysplastic foci and these are considered as precancerous lesions. Dysplastic foci (or dysplastic nodules) can be both low grade and high grade and both have the potential to develop into HCC, although high grade HCC has a much greater risk. The common pathophysiology that is involved in HCC is the repeated damage to hepatocytes that leads to cycles of cell death and regeneration which results in cirrhosis and instability in the genome of these cells leading to initiation of HCC. Multiple genetic events accumulate step wise including gene rearrangement, somatic mutations, alterations in copy number, epigenetic changes as well as alterations in growth factor pathways. These steps lead to progression of tumor and its metastasis.

The Role of Poor Lifestyle Habits
Disease conditions like non-alcoholic fatty liver disease and hepatitis C also require lifestyle modifications, as do those individuals who have undergone liver transplantation. These modifications include both dietary intervention and increase in physical activity. Most liver diseases affect particular cells of the liver more severely than others, for example, the damage caused by alcohol related liver disease affects cells which are located in the low oxygen venous parts of the liver, where the expression of detoxification enzymes is elevated.

Following are the liver diseases that have been recorded to occur due to lifestyle related causes:

Alcohol Abuse
Alcohol abuse has been linked with the development of liver disease. Its pathogenesis involve enzymes that alter the levels of acetaldehyde and reactive oxygen species (ROS). Both of these are products of alcohol metabolism. Higher levels of ROS reduce the antioxidative activity which allows oxidative damage to proteins, lipids and DNA. These molecules then serve as antigens that elicit an immune response in the host, also leading to inflammation reaction. The damage that ensues in the form of mitochondrial and autophagy dysfunction causes depletion of energy and the accumulation of cytotoxic mediators, ultimately culminating in cell death. Acetaldehyde also promotes the translocation of bacterial lipopolysaccharides to the liver; this stimulates the synthesis of cytokines involved in inflammation reaction. It is also responsible for disruption of lipid levels by impacting the transport of lipoproteins from the liver, decreasing the fatty acid oxidation and increasing its biosynthesis.

Alcohol influences production of hormones and cytokines by adipose tissues. Inflammatory state, as well as insulin resistance that are commonly seen in Obesity are also involved in alcoholic liver disease. Chronic alcoholism is also an important risk factor for development of HCC. There is correlation between the amount of alcohol consumed over lifetime and development of liver disease.

Obesity and Poor Dietary Habits
Majority of the patients with non-alcoholic fatty liver are obese. This disease is characterized by development of liver steatosis to non-alcoholic steatohepatitis. The distribution of the fat is also essential as people with higher levels of visceral fat are more likely to suffer from non-alcoholic fatty liver disease. In some human trials, it was seen that the consumption of beverages containing high fructose corn syrup is associated with development of liver cirrhosis. The ingested carbohydrates are a major stimulus for de novo synthesis of lipids in the liver High levels of free fatty acids that are derived from visceral adipose tissues, as well as chronic low grade inflammation that is often seen in obesity are two of the most important contributing factors to progression of liver injury. These adipose tissues also secrete adipokines which, along with accumulation of lipids in the liver, further promote inflammation.

Obesity and the metabolic syndrome are recognized as independent risk factors for reduced response to therapy and greater severity of the disease in Hepatitis C infection. Higher body mass index is associated with increased steatosis in patients who suffer from chronic HCV. With increasing severity of steatosis, there is a positive correlation with disease progression, worsening liver damage and fibrosis in patients with chronic HCV. The increased levels of circulating insulin that is found in obese individuals is considered to be associated with higher levels of fibrosis. Obesity also increases the severity of alcohol induced liver damage. Further, research has shown that excess of macro-components as well as deficiency in micronutrients are linked to increased severity of liver diseas in overweight and obese individuals. Thus, the treatment of this condition mainly includes anti-obesity medication and modification of lifestyle.

Heavy Smoking
In addition to harming the organs directly in contact with the smoke, smoking can also cause damage to other organs including the liver. Three major effects of cigarette smoking on the liver are direct and indirect toxic effects, immunological effects and oncogenic effects. The substances produced in the body have cytotoxic effects which increase necroinflammation and fibrosis. It also results in increase in the production of pro-inflammatory cytokines which can damage the liver. Smoking also causes polycythemia and increases red cell mass and turnover. This in turn causes iron overload disease which promotes oxidative stress in liver cells.

Smoking affects both branches of the immune systemhumoral and cell mediated. It acts by blocking the proliferation and by induction of apoptosis in lymphocytes. The elevated iron levels which induce oxidative stress and lipid peroxidation can activate stellate cells leading to the development of fibrosis.

Oncogenic substances produced by smoking increase the risk of hepatocellular carcinoma in patients who suffer from viral hepatitis and are independent of viral infection as well. Smoking tobacco also suppresses the tumor suppressor gene p53, while also suppressing Tcell response.

Among the indirect toxic effects of smoking are increase in carboxyhemoglobin and decrease in oxygen carrying capacity of red blood cells. It also increases the risk of developing hepatocellular carcinoma in patients with chronic liver disease

Diagnosis of Liver Disorders
Liver disorders can be diagnosed by blood tests, imaging tests, and tissue analysis.

Among the biochemical tests, the four major tests that are done to check for liver abnormalities are proteins, enzymes and other substances that are eliminated or processed by the liver and whose levels are altered in the case of liver injury. These tests can indicate the potential severity of liver injury as well as any changes in the status of liver health over time.
1. Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) Elevation in the levels of these enzymes indicates cellular damage from inflammation or cell death. ALT levels are higher than AST in case of acute liver damage as seen in hepatitis.
2. Gamma-glutamyl transferase (GGT) It is useful for detecting liver damage due to drugs and alcohol. It is also useful for follow up of chronic alcoholism and helps for detecting early rejection after liver transplantation.
3. Alkaline phosphatase (ALP) Elevated levels can indicate hepatobiliary disease and blockage of bile ducts, the pressure of the blockage stimulates the liver to produce more ALP.
4. Albumin Extensive loss of liver tissue which occurs in a long-standing disease can cause decrease in albumin levels. It is also reduced in case of malnutrition, malabsorption, nephrotic syndrome, chronic infections and alcoholic liver disease.
Tissue examination can include biopsy, wherein a part of the liver is sampled and assessed microscopically for damage to liver, as well as for diagnosis of cancer.

Following imaging tests can be performed for detection and diagnosis of liver diseases
Abdominal Ultrasound A technique which uses ultrasound to create pictures of the liver, it can allow the evaluation of blood flow to and from the liver.
Abdominal Computed Tomography (CT) scan A procedure that combines X-ray equipment with computers that produce digital images of the liver. It can help determine the severity of liver cirrhosis.
Magnetic Resonance Imaging (MRI) In this technique, a strong magnetic field is used to obtain detailed images of the liver which can detect the damage caused by various liver disorders.

Many liver disorders are asymptomatic; it is easy to fall into the sway of creature comforts and ignore the fact that our actions have consequences unseen. Our liver is an organ that tirelessly functions in systems as diverse as digestion and immunity. The silver lining to this cloud is the fact that for a very long time, damage to liver caused by lifestyle is reversible. This is indeed the best example that mending our ways in time can avert a greater calamity in the future.


View Our Editorial Policy
Was this article helpful?

Trending Health & Fitness Web Stories

Find Latest Health Web Stories, Fitness Photo Stories, Health AMP Stories.VIEW ALL

Did you catch our latest post? JOIN US

Facebook LinkedIn Instagram Twitter YouTube

Contact Us

Email: info@healthcareontime.com | Phone No: 09220145540 | Whatsapp: 9820693367
  • Copyright 2024 HealthCareOnTime.com, All Rights Reserved
  • Disclaimer: HealthcareOnTime offers extensively researched information, including laboratory testing for health screening. However, we must emphasize that this content is not intended as a substitute for professional medical advice or diagnosis. Always prioritize consulting your healthcare provider for accurate medical guidance and personalized treatment. Remember, your health is of paramount importance, and only a qualified medical professional can make precise determinations regarding your well-being.
DMCA.com Protection Status HealthCareOnTime.com Protection Status HealthCareOnTime.com Protection Status