Author - Dr. Sunil Pawar

1. New onset IBD in old age along with younger diagnosed patient getting older, it is estimated that by 2033, 1 in 3 IBD patient will be above 60 years
2. There is no typical IBD patient. There are various ways that IBD can affect a patient; some 60-year olds will have the same physical capacities as many 20-years-old IBD patients. Other people experience declines in physical and different abilities at much younger ages.
3. Late-onset IBD differs from early onset in many aspects, including location and phenotype of the disease at diagnosis, symptoms at presentation, and natural disease progression
4. Limited coordination skills may impact the patient’s ability to successfully self-administer topical treatment like suppositories.
5. Diagnostic challenges : There are different mimics of IBD like infectious colitis, segmental colitis associated with diverticular disease, nonsteroidal anti-inflammatory drug-induced intestinal injury and ischemia.
6. There is need for more scientific research. Only small proportion of participants enrolled in IBD clinical trials are made up of people with IBD aged 60 years and over. This results in underutilized appropriate therapeutic management decisions in this population
7. Comorbidities: People with IBD aged 60 years and over have many comorbidities like blood pressure , Diabetes , Heart diseases, neurological diseases. Surgical management has more risk than young age.
8. Polypharmacy: Given the higher incidence of age-related comorbidities, people with IBD aged 60 years and over are more likely to take a wide range of medicines . Drug interactions need to consider in prescription. Risks of the immunosuppressant drugs is more as low immunity and nutrition issues more in old age.
9. Cognitive decline and Neurological diseases are common in old age . These leads to poor adherence to therapy and cooperation in disease management
10. Unequal access to treatment as compared to young age as many old age people require support in travel, administering Medications.
11. Colonoscopy procedure is slightly more risky in old age due to difficulty in bowel preparation, mobility issues, Multiple comorbidities, anaesthesia related issue.
12. Lower life expectancy in elderly IBD as compared with patients without IBD
13. Frailty defined as a state of decreased physiological reserve. This was independently predictive of worsening mobility, hospitalization , post operative complications, Infections.
14. Inflammaging: Cellular aging leads to state of chronic inflammation. This is related to biological aging. This inflammaging is more pronounced in IBD patients. This further aggravates the egeing related disorders in IBD patients. There is more prevalence of dementia , DM , Cardiovascular diseases , Osteoporosis.
15. Prescription and Management : Core strength exercises , Nutrition, Limit polypharmacy , Home interior to suite old age to prevent fall.

 

Fatty liver related disease; Your questions: My answers

 

Q 1 . How common is fatty liver related liver disease ?

 

In India, the prevalence of fatty liver related disease in the general population varies from 9 to 53%. The prevalence among patients with diabetes mellitus was reported to be 56.5%.

 

Q 2. Can fatty liver disease run in families ? Genetic? Hereditary?

 

Yes. Certain genetic disorders and mutation can run in family. These can lead to fatty liver related diseases.

 

 

Q 3. Is fatty liver common in children?

 

Yes

The prevalence of 12.4% to 63.4% Indian children

 

Q 4. Which children should be screened for fatty liver related diseases ?

 

The screening with blood report

1.Obese children above 9 years of age

2.Overweight children with family history of NAFLD or other risk factors.

 

Q 5. What are the stages of fatty liver related disease?

 

It can be categorised in 3 broad stages  Fatty liver,  Non alcoholic steatohepatitis (NASH) , cirrhosis

 

Q 6. What is NASH?

 

NASH has fatty liver with hepatic inflammation and or fibrosis

 

Q 7. What is lean NASH? Can fatty liver disease happen to thin individuals?

 

Around 10–20% of patients with fatty liver related disease may have normal body mass index and normal waist circumference.

 

Q 8. What do I feel in fatty liver disease ? Is fatty liver painful? Does fatty liver cause gas?

 

 

Generally there are no symptoms. Some patients may feel fatigue, weakness. In advanced liver disease / cirrhosis patient may develop fluid in tummy, leg swellings, jaundice, gas related issues.

 

 

Q 9. What is the reason for fatty liver disease ? What is the main cause of a fatty liver?

 

When fat accumulates in liver beyond certain limit it start affecting liver functions and causing damages. Excess calorie consumption than required is main reason.

 

 

Q 10. What food causes fatty liver disease? Which food is harmful for liver?

 

Weight gain is most important reason. Junk or high calorie diet like fast food , samosa, sweet’s, Wada pav, juices, soft drinks, alcohol, refined sugars, saturated fat.

 

 

Q 11. Which individuals should be screened for fatty liver related diseases?

 

1. Overweight and obese individuals
2. Patients with DM, Obesity ,Metabolic syndrome, PCOS

 

 

Q 12. Which other organs affected by fatty liver related disease?

 

Other disease associated with fatty liver related disease are Heart disease , kidney disease, bone related issues like osteopenia and osteoporosis, PCOS, stroke, hormone related issues like hypothyroidism, obstructive sleep apnoea.

 

 

Q 13. Is there increased risk of cancers in fatty liver diseases?

 

Yes. There is increased risk of HCC, carcinoma colon, gastric cancer, carcinoma pancreas, uterine and breast carcinoma.

 

Q 14. How much time to develop advance disease in fatty liver related disorder ? Is fatty liver serious problem? Can I live with a fatty liver?

 

It depends upon present state of liver. This can be known with the help of fibroscan.

Time to development of advanced liver disease is

22–26 years in F0-1 fibrosis

9.3 years in F2 fibrosis

2.3 years in F3 fibrosis

 

 

Q 15. What blood tests show fatty liver? Does fatty liver show in LFT?

 

Fatty liver is shown on ultrasound.  Blood tests help to assess the fatty liver related injury to liver.

 

Q 16. What is Stage 1 fatty liver?

 

Ultrasound will detect fatty liver and categorised it into 3 grades, Fatty liver 1,2 and

3. It depends upon amount of fat deposition in liver. Grade 1 Fatty liver has less fat

deposition in liver than grade 3. It does not necessarily mean Fatty liver grade 3 is

more severe form than grade 1.

 

 

Q 17.  Which is good available non-invasive test to detect permanent or chronic liver damage?

 

Fibroscan , MR elastography, ARFI

 

 

Q 18. How do I manage fatty liver related diseases? How to reduce my fatty liver ? Can fatty liver be cured? What is the fastest way to cure a fatty liver? How can I normalize my fatty liver naturally? How long does fatty liver take to heal?

 

 

Yes in early fatty liver disease with mild inflammation and mild fibrosis can be cured over months with right approach but advanced fatty liver related disease has to be controlled, it is in sense damage control mode approach. Following are the ways,

1. Risk factor modification: overweight or obesity, type 2 diabetes mellitus (T2DM), hypertension, and dyslipidemia.

 

2. Weight reduction 10% through diet , lifestyle exercise, Exercise . brisk walking, jogging, running, swimming, or cycling for 30–45 min/day at least 5 days in a week (at least 200 min per week) to achieve a target heart rate of 60–70% of maximal heart rate.

 

3. Medication : saroglitazar, Vit E , obetocholic acid, semaglutide , liraglutide.

 

4. Bariatric surgery and endoscopic Bariatric procedure

 

Q 19. Which diet or fruit is best for fatty liver ? Which fruit is best for liver?

 

Low calorie and adequate protein diet. So no particular food types are best. Final goal is to reduce weight and build muscle mass.  High fiber diet, vegetables, fruits should be included in diet.

 

Q 20. Which exercises are good for fatty liver ?

 

Aerobic and muscle strengthening  exercises are important. Good muscle mass replaces some of the liver related functions and gives rest to liver. Also poor muscle mass is poor prognostic factor in liver disease.

 

 

Q 21. Will lean NASH patient benefit with weight loss or exercise ?

 

Yes.

exercise improves insulin resistance and hepatic steatosis even without weight loss.