World Liver Day2022: How conscious are Nigerians of Liver Health

The liver is situated on the right side of upper abdomen, beneath the rib cage. The gallbladder, a portion of the pancreas and intestines, are located beneath the liver. These organs function in harmony to digest, absorb and process the food consumed.

The main function of the liver is to filter blood, detoxify chemicals and metabolize drugs. It also makes proteins essential for blood clotting and other functions. If the liver is overburdened, it cannot function optimally, and the result is damage to the liver and other parts of the body.

The World Health Organization (WHO) data, published in 2018, said Liver Disease Deaths in Nigeria reached 60,044 or 3.10 per cent of total deaths.

The age adjusted Death Rate is 64.44 per 100,000 of population. It ranks Nigeria second in the world.

Liver disease accounts for approximately two million deaths per year worldwide, one million due to complications of cirrhosis and one million due to viral hepatitis and hepatocellular carcinoma. Cirrhosis is currently the 11th most common cause of death globally and liver cancer is the 16th leading cause of death; combined, they account for 3.5 per cent of all deaths worldwide.

Cirrhosis is within the top 20 causes of disability-adjusted life years and years of life lost, accounting for 1.6 per cent and 2.1 per cent of the worldwide burden.

About two billion people consume alcohol worldwide and upwards of 75 million are diagnosed with alcohol-use disorders and are at risk of alcohol-associated liver disease.

Approximately, two billion adults are obese or overweight and over 400 million have diabetes; both of which are risk factors for non-alcoholic fatty liver disease and hepatocellular carcinoma. The global prevalence of viral hepatitis remains high, while drug-induced liver injury continues to increase as a major cause of acute hepatitis.

Liver transplantation is the second most common solid organ transplantation, yet less than 10 per cent of global transplantation needs are met at current rates.

Though these numbers are sobering, they highlight an important opportunity to improve public health given that most causes of liver diseases are preventable.

This World Liver Day focuses on ways to maintain a healthy and proper-functioning liver.

On the account of World Liver Day 2022, though the theme for this year has not been released, the theme for last year World Liver Day is "keep your liver healthy and disease-free."

The World Liver Day is observed every April 19 to spread awareness about liver-related diseases. The Liver is one of the most important organs and second-largest in the body. It is also considered to be one of the most complex organs that perform crucial body functions such as digestion, immunity, metabolism and nutrition storage.

The liver is an organ which can be easily damaged if you don't take good care of it.

Liver works hard, performing hundreds of complex functions, including "Fighting infections and illnesses, regulating blood sugar, removing toxic substances from the body, controlling cholesterol levels, helping blood to clot (thicken) and releasing bile (A liquid that breaks down fats and aids in digestion).

Liver disease doesn't usually have any obvious signs or symptoms until it is fairly advanced and the liver is damaged. At this stage, possible symptoms are loss of appetite, weight loss and jaundice, according to a 2013 study aimed to determine the pattern and risk factors of liver disease in a Nigerian tertiary hospital, the University of Nigeria teaching hospital Ituku/Ozalla, Enugu state, Nigeria.

The study found out that Liver diseases accounted for 7.9 per cent of medical admissions, with primary liver cancer and liver cirrhosis accounting for 44.3 per cent and 20.4 per cent respectively.

The main risk factors are alcohol consumption (52.1 per cent), hepatitis B virus infection (49.4 per cent), ingestion of herbs and roots (45.5 per cent) and cigarette smoking (30.1 per cent).

The study concluded that Liver cirrhosis and primary liver cancer account for two thirds of liver diseases in hospitalized patients in a Nigerian tertiary hospital.

The major putative risk factors are alcohol consumption, hepatitis B virus infection, use of herbs and roots and smoking.

Also, a study has shown the pattern, clinical presentations, risk factors and determinants of morbidity and mortality in patients with liver disease sufferer admitted into a tertiary hospital in Ile-Ife, Nigeria.

The over five-year period (2013–2017) of study found out that a total of 5,155 patients were admitted, liver diseases accounted for 324 (6.3 per cent) of medical admissions within the period, with hepatocellular carcinoma (HCC) accounted for 52.8 per cent, liver cirrhosis (LC) – 27.2 per cent, acute hepatitis – 10.38 per cent, metastatic liver disease – 4.1 per cent, autoimmune hepatitis – 1.7 per cent, DILI – 0.7 per cent, liver abscess – 1 per cent, abdominal tuberculosis – 1.4 per cent, and unclassified etiology – 1.76 per cent.

The Southwest Nigerian tertiary hospital's five-year study of the pattern of liver disease admission, said that a total of 139 cases were Hepatitis B surface antigen (HBsAg) positive, 64 took alcohol, 67 took herbs, while 57 took self-prescribed medications.

Mortality among all patients admitted through the emergency compared with the medical clinic was 81.9 per cent versus 18.1 per cent.

Elevated creatinine, coagulation disorder, hypoalbuminemia, and hypokalemia contributed to mortality.

The study concluded that HCC and LC accounted for the majority of liver diseases in hospitalized patients with high mortality among all patients admitted through the emergency department and those with elevated creatinine, coagulopathy, and low potassium and albumin.

Major etiologic factors were hepatitis B virus infection, alcohol, and self-prescribed medications.

Another study from the South–South zone (Calabar) of Nigeria showed high prevalence rate of chronic liver disease with hepatitis B and C associated prevalence at 62.3 per cent and 12.3 per cent respectively.

The south south study showed that there was also high incidence of chronic liver disease among children in Nigeria and this has been attributed to inflammatory disorders and tumors – 33.3 per cent respectively, cirrhosis/fibrosis (28.6 per cent) and metabolic (storage) diseases (4.8 per cent) as well as neonatal hepatitis followed by giant cell hepatitis and viral hepatitis (33.3 per cent).

This study shows that the burden of chronic liver disease was a major health concern globally due to its high prevalence both in the developed and low- and middle-income countries with increasing mortality rate of 59 per cent.

According to Dr Patrick Chinedu, a Public Health specialist, an unhealthy liver creates unwanted symptoms such as jaundice, abdominal pain, and swelling, bloody stool, chronic fatigue, nausea, vomiting, etc. and may eventually progress into life-threatening disease and liver failure.

Chinedu said the over-consumption of alcohol. Over-drinking can result in alcohol hepatitis (inflammation and destruction of liver cells) and cirrhosis "where healthy liver tissue gets replaced by scar tissue and the liver can no longer function properly on a permanent basis".

"The liver is damaged by immoderate drinking because it cannot quickly process the amount of alcohol consumed. The liver also needs water to help process the toxin and alcohol is a diuretic, which dehydrates the body. For a healthy liver, abstain from consuming alcohol or moderate its use," he advised.

The expert said that in Nigeria, there is high incidence of chronic liver disease with varying degree of prevalence reported in different geopolitical areas across the country.

"These have been attributed to low vaccination rate, and lack of effective national policy on chronic liver disease treatment and prevention.

"Though there are implantations of HBV vaccination programme worldwide, however, the intervention needs to be assessed to actively involve vaccination of pregnant women and newborns, since mother-to-child transmission accounts for almost all cases of CHB in Africa and Asia, alongside national programmes on hepatitis C should be instituted as programme have been developed in some countries but do not exist in most, including regions with the highest prevalence," he said.

Chinedu advised that early diagnosis would certainly be cost-effective, as it would create room for management and administration of available drugs as this would prevent cirrhosis and carcinomas from setting in.

He, therefore, said that these approaches, as well as incorporation of laboratory diagnosis of liver diseases into routine laboratory diagnosis across the country would enhance early diagnosis, and greatly reduce the burden of chronic liver diseases not only in Nigeria but globally.

"Therefore, World Liver Day acts as a reminder to keep aware of and knowledgeable about liver diseases.

"On World Liver Day, let us stand alongside all those suffering from liver ailments and let them know they are not alone in their fight.

"As Nigerians, if we want to live a healthy life and make a difference in the world, it's time for us to start taking care of ourselves and loved ones.

"We won't always be able to detect Hepatitis signs, so let's be cautious. It is good for us to learn more about our organs on this World Liver Day," he advised.

According to Dr Michael Greger, an American physician and advocate of a whole-good, Plant-based diet, berries are the healthiest fruit, offering potential protection against cancer and heart disease, boosting the immune system and acting as a guard for the liver and brain.

The late American poet, memoirist, and civil rights activist, Maya Angelou, said; "life loves the liver of it."