New Delhi: The liver is considered the most complex organ in the body and performs various functions. If it gets damaged, it can have serious repercussions for those suffering from it and can lead to hepatic diseases. Non-alcoholic fatty liver disease (NAFLD) has become the most prevalent chronic liver disease worldwide due to the increasing burden of obesity and diabetes.
However, due to a lack of therapeutic medicine, lifestyle management continues to be a successful strategy for NAFLD. NAFLD is a condition in which fat accumulates in the liver cells, leading to inflammation and damage to the liver. NAFLD can range from simple fatty liver, which is a benign condition, to nonalcoholic steatohepatitis (NASH), which can progress to cirrhosis and liver failure. The exact cause of NAFLD is not known, but it is thought to be related to a combination of genetic, environmental, and lifestyle factors.
Studies suggest that high salt and sugar intake may increase the risk of developing NAFLD. High salt intake can lead to hypertension, which is a risk factor for NAFLD. It can also cause oxidative stress and inflammation, which can contribute to the development of liver damage. Whereas overloading sugar can cause insulin resistance that can contribute to the accumulation of fat in the liver cells and further lead to NAFLD.
To get a sense of what experts have to say about the role played by excessive salt and sugar intake in NAFLD, ETHealthworld, on the occasion of World Liver Day, spoke with medical specialists, who addressed some of the most frequently asked questions (FAQs) surrounding the disease.
What is the association of liver disease with sodium intake in terms of frequency of consumption?
Patients suffering from non-alcoholic fatty liver disease (NAFLD) should limit their sodium intake, as high sodium intake can lead to fluid retention, high blood pressure, and exacerbation of liver damage, suggests Dr Darius Mirza, Lead Consultant Liver and HPB Programme, Apollo Hospitals Western Region. “These patients should aim to consume a low-sodium diet, which means limiting processed and packaged foods and avoiding adding salt to meals. They should also focus on consuming a diet rich in fruits, vegetables, whole grains, and lean proteins,” mentioned Dr Mirza.
If salt consumption is unrestricted in a patient with liver cirrhosis (the most severe stage, which develops after years of inflammation and where the liver shrinks, this damage is permanent and can cause liver failure) and has advanced liver damage, then they can develop ascites, which means fluid buildup in the abdomen alongside swelling in the whole body, especially the legs, and the body’s urine flow also becomes less and the possibility of hospitalisation becomes higher, elaborates Dr Manish Kak, Gastroenterologist, Manipal Hospital, Ghaziabad.
Does excessive salt intake accelerate NAFLD in diabetics and obese?
Salt alone doesn’t have a direct impact on developing NAFLD, but overloading salt for a long time can increase the chances of developing hypertension. Dr Gaurav Gupta, Senior Consultant and Chief Surgeon, Liver Transplant and HPB Surgery, Fortis Hospital, Mulund, explained, “Hypertension is a risk factor for NAFLD. Problems associated with excessive salt consumption, such as hypertension, can proliferate the chances of advanced stage liver diseases in patients already living with NAFLD and other lifestyle diseases like diabetes.”
According to Dr Mirza, excessive salt intake can accelerate the development of NAFLD in patients who are already obese and diabetic. People with a high body mass index and diabetes are at greater risk of developing fatty liver disease, and a high-salt diet can exacerbate this condition by increasing blood pressure and promoting inflammation in the liver.
Can simple fatty liver disease advance into NASH, or fibrosis with callousness and consistent overloading of salt and sugar?
Explaining that an individual already diagnosed with fatty liver disease alongside diabetes has to decrease the consumption of sugar, Dr Kak says, “Sugar means calories that have to be cut down because whatever food we eat, whether it is sugar, fat, or oil, ultimately the liver converts it into fat. That fat gets deposited in the liver, and with the increasing amount of fat, the tendency of the liver to go from simple fatty liver (steatosis) to NASH or to advance into the extreme stage of liver fibrosis will increase.”
Experts highlight that simple fatty liver disease can progress to NASH and eventually to fibrosis and cirrhosis, especially in patients who have poor dietary habits that include high levels of salt and sugar. A diet that is high in salt can promote liver damage by causing oxidative stress and inflammation, which can contribute to the development and progression of liver disease.
Can patients living with NAFLD develop other serious conditions?
Patients with NAFLD who consume high levels of salt are at greater risk of developing cardiovascular disease and hypertension. Dr Mirza elaborated, “This is because a high-salt diet can increase blood pressure, which can put a strain on the heart and blood vessels. In addition, excess salt intake can promote the accumulation of fat in the liver, which can contribute to the development of the metabolic syndrome and increase the risk of cardiovascular disease.”
It is estimated that nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disorder, affecting 25.24 per cent of the general adult population and 59.67 per cent of diabetic patients worldwide, as per a study published in the peer-reviewed Current Pharmaceutical Design medical journal.
The metabolic syndrome, which encompasses obesity, insulin resistance, high blood pressure, and high cholesterol levels, and NAFLD are strongly related. Additionally, it has links to other illnesses like type 2 diabetes and sleep apnoea. “If somebody has a fatty liver, other than the fatty liver tests, we also have to advise for a cardiac consultation and other related checkups as well, because people suffering from fatty liver can survive but generally they can have a cardiac event anytime,” added Dr Kak.
How can NAFLD patients maintain good liver health?
Doctors suggest that withdrawing from high levels of salt and sugar intake can help reverse some of the damage to the liver at an early stage, but it may not be able to fully restore liver function. Patients with NAFLD need to limit their cravings for sugar and sodium and adopt a healthy lifestyle to prevent further liver damage and improve liver function.
Excessive sodium intake can have several negative effects on the liver. It can lead to the accumulation of fat in the liver, which can cause inflammation and oxidative stress. This, in turn, can damage liver cells and impair their ability to function properly. The liver deals with excess sodium by filtering it out of the blood and excreting it in urine. However, if the intake of sodium is consistently high, it can lead to the development of liver disease.
The World Health Organisation (WHO) advises limiting salt intake to no more than 5 grammes (or about one teaspoon) per day. This can be accomplished by consuming fewer processed foods, which are frequently rich in salt, and by seasoning food with herbs and spices rather than just sodium.
To maintain good liver health and prevent further deterioration in patients with NAFLD, Dr Gupta said, “It is important to follow a balanced diet that is low in carbs, trans fat, sugar, and salt and rich in fruits, vegetables, and whole grains. It is observed that patients who cut 10 per cent of their original weight with persistent lifestyle modification along with exercising 150-180 minutes a week see a significant change in their liver’s health.
Patients should limit their sodium intake to less than 2,300 mg per day (or less than 1,500 mg per day if they have hypertension). Doctors’ advice to patients is to avoid alcohol and tobacco, as these can further damage the liver.
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