EDITORIAL
Goa should match liver screening efforts with robust follow-up healthcare services
‘Liver Forever’ is on its way. This first-of-its-kind statewide public health initiative undertaken by Goa aims to screen 3,00,000 adults over the next three years for Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD). Primary and community health centres will focus on people at higher risk – those with obesity, diabetes, hypertension and the like. They will receive lifestyle counselling and further diagnostic evaluation, if necessary. The goal is to detect liver disease early and prevent its progression to Metabolic Dysfunction-Associated Steatohepatitis (MASH), fibrosis, cirrhosis and potentially even liver cancer, according to the government announcement. Given today’s fast-paced lifestyle, liver-related complications can be far more widespread than suspected. Hence, it would not be wrong to say that the move represents a shift towards proactive, population-scale management of non-communicable diseases.
MAFLD and MASH are acronyms most of us have never heard before. From the information available, MAFLD is a condition in which excess fat accumulates in the liver. It occurs due to metabolic problems such as obesity, type 2 diabetes, high blood pressure, abnormal cholesterol levels or insulin resistance. Contrary to what one might think, this kind of liver disease is not primarily connected with alcoholism.
Some people with MAFLD develop Metabolic Dysfunction-Associated Steatohepatitis (MASH). This is a more severe form in which the fatty liver becomes inflamed and liver cells are damaged. Over time, MASH can lead to scarring (fibrosis), cirrhosis, liver failure or even liver cancer if left untreated. It is caused by a combination of an unhealthy diet, physical inactivity, excess body weight and genetic factors. However, it can occur even in those who are not overweight. Scientific opinion suggests that weight loss, regular exercise and a balanced diet can halt or reverse it. Medical studies indicate that lifestyle modification is the most effective treatment for MAFLD, but also the hardest to sustain. MAFLD is now one of the world’s most common chronic liver diseases. It affects 30-40% of adults globally, 36% in Asia and 40% in India. Of MAFLD cases, 10-30% could progress to MASH.
Goa appears to have a particularly high burden. One community-based study of urban adults conducted by Goa Medical College researchers found a prevalence of about 49%. This is significantly higher than many national estimates. This high prevalence is one of the reasons the Goa government has launched a statewide fatty liver screening programme.
In Goa, the Directorate of Health Services (DHS) will partner with Zydus Healthcare, and the Goa Medical College will serve as the tertiary referral centre for specialised investigations and management. PHCs and CHCs will also be roped in. The high-risk population will be the focus.
An investment in the health of the people is an investment in Goa’s future, provided it is carried out with proper logistical support and fiscal prudence. It also needs scientific rigour, equitable access, sustained public education and timely follow-up care. Data security and privacy could also be issues here. Linking health data to a universal database increases the risk of data breaches.
The demand for treatment will rise once the screening results are available. Beyond screening, its success will also depend on whether those identified as being at risk receive effective counselling, treatment and long-term support to adopt healthier lifestyles. This includes having sufficient endocrinologists, nutritionists and counsellors available to handle newly identified patients. In short, the move is definitely positive, but much depends on its implementation and on how it handles the related issues. The government will have to be prepared with a long-term support system.
