Fast food leads to chronic diseases

By Dhaneshi YATAWARA

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In today's world, where all of us work in a hurry, its nothing but rush, rush and rush from one place to the other. With the sophistications that came wrapped so neatly in the package of so-called modernisation, commercialisation and globalisation, we lost the plain but meaningful life our ancestors enjoyed. They had time for health as well as wealth. Today, the transformation is such it is only for wealth we have time and not even a giffy for health. Instead of a quiet simple cooling lunch against our hot weather we prefer stuffing our stomaches with short-eats while running to the next appointment. These foodstuffs of the new era can transform our body systems from bad to worse.

Hamburgers, hotdogs, chips, Chinese rolls, cutlets, pastries, cakes have become our mouthwatering delicacies in place of kevum, kokis, aasmi, mun kevum, thala guli (gingerly rolls),

 aggala which we used to eat only during especial occasions. The 'takeaway' that is hot, extremely oily, soaked in an assortment of sauces have become our main meal in office and very tragically in our sweet homes as well. Instead of a beautiful, rich and healthy lunch with kekulu bath and few curries including the lush green kola melluma we have become so greedy of fried rice and curries with a hidden load of harmful chemicals. Though we sense these as treats for our taste buds the liver faces fatal conditions with the storage of an immense load of fats; Thus, causing a fatty liver. These factors cause a newly recognised liver disease - the fatty liver disease. This is associated with the prosperity of a society and even the onset of obesity, overweight, hypertension and diabetes mellitus is associated with well-to-do people. We are not alone. According to studies this is becoming more prevalent in Asia as many Asian countries are enjoying good economic growth and prosperity over the last few decades.

Sri Lanka is blessed compared to many Asian countries since other diseases, i.e. chronic hepatitis B and C, which can make the liver unhealthy are not prevalent. According to various studies over the past few years liver cirrhosis and liver cancer are the major health problems the Asian continent face. This is because various causes of chronic liver diseases are common in many parts of Asia. "Chronic hepatitis B is common in countries like China, Hong Kong, Thailand with approximately 10 - 20% of the general population being hepatitis B carriers," says Dr. Desmnd Wai, Consultant Gastroenterologist and Hepatologist of the Asian Centre for Liver Diseases and Transplantations of the Glenegeagles Hospital in Singapore. Chronic hepatitis C is also common in certain countries such as Mongolia, Pakistan, Myanmar and parts of Indonesia, Dr. Wai added.

As Dr. Wai revealed Sri Lanka is fortunate with the low prevalence of hepatitis B and C, however, about 20% of the population suffers from fatty liver disease while liver cirrhosis and liver cancer remain as two major causes of major health issues in Sri Lanka.

Recent studies from China have also showed that the level of hepatitis B virus is directly related to the risk of developing cirrhosis and liver cancer.

The tragedy is with the up to date research and studies on medication so far no one was successful in finding a cure for fatty liver disease. "The only proven treatment for fatty liver disease is still weight loss, doing regular excercises and eating a healthy diet," Dr. Wai said explaining elaborately the risks of having a fat filled liver. Liver cirrhosis is an endstage liver disease characterised by significant scarring of the liver. It is the end result of chronic liver injuries such as chronic hepatitis B, C and fatty liver disease. The liver plays a major role in the smooth functioning of the body. It removes toxins from the body and fights infections as well as maintaining the water balance and nutrition. These are some of the numerous functions the liver contributes to the human body. Hence, patients with liver cirrhosis also suffer from complications like accumulation of fluid in the abdomen, weight loss, infections and mental confusion, Dr. Wai said continuing his highly technical yet simplified explanation. Many new treatments are now available for individual liver diseases such as hepatitis B, C and fatty liver disease. However, once the patient develops cirrhosis or liver cancer, they must be quickly evaluated at a tertiary liver centre and to consider various palliative and curative options including donor liver transplant. Treatment for cirrhosis or management of cirrhosis (which is technically more suitable) is divided in to two - i.e. palliative and curative. Palliative treatment aims at relieving symptoms of complications of cirrhosis, such as endoscopic variceal ligation for variceal bleeding, diuretics for ascites, laxatives for hepatic encephalopathy. But palliative measures do not prolong lifespan of patients with advanced cirrhosis, he added. The extended lifespan is generally two years. "The definitive treatment is liver transplantation, where the whole sick liver is removed and a new piece put in for replacement," Dr. Wai says.

In Singapore, chronic liver disease as a result of cirrhosis and cancer has become one of the leading causes of death, The Asian Centre for Liver Disease and Transplantation states. Accordingly, in recent years there has been an increase in the number of patients seeking treatment for liver diseases and those needing transplantations.

Liver cancer is the third commonest cancer in Singaporean males and is among the top cancers in most Asian countries, Dr. Wai adds. Similar to many other cancers patients with liver cancer do not show symptoms at the early stages. By the time patients present with symptoms like abdominal pain, weight loss or jaundice then their cancer is already in an advanced stage. It is recommended that patients with any form of chronic liver diseases such as hepatitis B or C to be reviewed by a doctor every 6 - 12 months to screen for any cancer. The bright side of the story is liver cancer diagnosed on screening at an early stage is usually at a curable stage. Management of Heptocellular carcinoma is also divided in to palliative and curative. Palliative measures include chemoembolisation, radiofrequency ablation and systemic chemotherapy. Survival of patients with any of these palliative measures is poor and most patients die within 18 months - even with the latest oral chemotherapy. Curative treatment for liver cancer consists of either surgical resection or liver transplant. If the tumour is limited within anatomical margin with a good remaining liver reserve, then liver resection is the best treatment. But for patients with liver cancer spanning both left and right lobes of the liver or if the liver reserve is poor due to the presence of cirrhosis then liver transplant would be the best treatment. It removes the cancer and replaces the cirrhotic liver.

The human liver has an extraordinary reserve and potential to regenerate. A healthy person can maintain a normal life even if he or she loses 70% of the liver. Within two months, the liver would regain almost 100% of its original functions and within 12 months the liver would regrow to its original proportions. As Dr. Wai explained this regenerative potential allows us to perform living donor liver transplant. As always the live donor should be healthy, of compatible blood group, emotionally or genetically related and volunteers without cohesion of financial gain.

At the Asian Centre for Liver Disease and Transplantation at Gleneagles Hospital, Singapore 25 - 30 living donor liver transplants are performed yearly. 70% of the donors are relatives of the patient - i.e. children, parents or nephews. The other 30% of donors are friends, employees or colleagues.

Dr. Wai revealed an incident more significant to us. One of the patients having an unresectable liver cancer which reocurred and had no potential donor in his immediate family. He was a Sri Lankan living in Colombo. Fortunately, a Buddhist monk came forward as the donor. " They underwent a successful live donor liver transplant more than a year ago and both are doing very well," Dr. Wai states.

"Nowadays, at experienced centres such as our unit in Singapore, longterm survival rate after live donor liver transplant is approximately 85% giving a new lease of life to many patients with liver cirrhosis and liver cancer.

The Centre is unique as it offers highly specialised and diverse medical expertise, with state of the art equipment and facilities. All these are established within a single medical institution providing comprehensive and seamless care for both children and adults with liver diseases.

The Centre also comprises a liver Intensive care unit to complement a highly successful Liver Transplant Programme. The Asian Centre for Liver Disease and Transplantation features two main facilities - i.e. Liver ICU and Liver Transplant Programme. The Liver Transplant Programme comprises a team of highly experienced and dedicated doctors. It is spearheaded by a renowned transplant hepatobiliary surgeon, who has successfully performed many liver transplant procedures including living donor liver transplant in Singapore as well as overseas.

State of the Art technologies and sophisticated equipment are used to facilitate disease treatment and patient recovery. Strategic alliance with King's College Hospital Liver failure unit in London has been established to provide sophisticated surgical programmes, high level procedure protocols as well as technology transfer. With the presence of the Asian Centre for Liver Disease and Transplantation, patients with liver disease from the regional countries can conveniently and cost-effectively seek quality and advanced treatment in Singapore.