In the last one-year COVID-19 and its complications have attracted unprecedented attention from the general public, doctors and policymakers alike. This has led to an unfortunate lack of attention on indolent diseases like diabetes, hypertension, fatty liver to name a few. Here, we attempt to demystify the impact of liver conditions on COVID-19 progression and provide guidance on liver care during COVID time.
What is NASH?
NAFLD (Nonalcoholic fatty liver disease) or Fatty liver is an indolent disease affecting approx. 25 per cent of the global population. Fatty liver disease comprises a spectrum of liver anomalies ranging from nonalcoholic fatty liver to NASH (Nonalcoholic steatohepatitis) and liver cirrhosis. Nonalcoholic steatohepatitis (NASH) is the advanced form of nonalcoholic fatty liver disease (NAFLD) and 10 to 25 per cent of them can progress to liver cirrhosis in 10 years' time. Considering the prevalence of NAFLD in India is about 9 per cent to 32 per cent, the absolute numbers that may require attention is be very huge. It is necessary to detect this condition early, analyze the risk factors for its progression and adopt strategies to prevent disease progression. NAFLD can affect people of any age, including children.
How COVID impacts the liver functioning
Liver enzymes are often elevated in up to 83 per cent of hospitalized patients with COVID-19. Patients with severe COVID-19 infection are more susceptible to liver injury. It is difficult to ascertain whether alterations in liver functions are due to SARS-CoV-2 infection and associated complications and/or drug-induced liver injury. Mortality from COVID-19 is higher in more advanced liver disease and is strongly associated with hepatic decompensation. NAFLD is associated with progressive COVID-19 and leads to poor outcomes independent of obesity and comorbidities.
Effect of COVID-19 vaccination on liver diseases
There is a lot of apprehension amongst patients with liver disease to take the COVID vaccine. Safety and efficacy data of COVID-19 vaccines in chronic liver disease patients is limited. However, adverse events are not expected to be more frequent in patients with chronic liver disease. Also, efficacy is not expected to be lower than the general population. Further studies on the impact of vaccination in chronic liver disease are in progress. It is highly recommended that all adults with liver disease, especially those waiting for liver transplantation must receive COVID-19 vaccine.
How to prevent or delay the onset of NASH
All over the world, work from home or study from home has become the new normal. One of the unfortunate falls out of this situation is physical inactivity in young adults and kids. This sedentary
lifestyle coupled with unhealthy eating is a welcome recipe for fatty liver disease, especially NASH. Some of the ways one can reduce the risk of getting the condition are:
- Keep a regular watch/check on what you eat.
- Inculcate a disciplined life with regular exercises
- Do not overuse any medication until and unless prescribed by the doctor
- It is important to treat and control diabetes, elevated cholesterol and hypertension
- Food rich in monounsaturated fatty acids like nuts, almonds, cashews, eggs, fish, coconut oil, safflower oil may be beneficial.