The clinic will focus on the newly-recognised Metabolic Dysfunction-Associated Fatty Liver Disease, aiming to halt its progression especially in diabetics.
The team behind the Diabetes Liver Clinic, (Supplied)
In India, where over 101 million people are living with diabetes and 136 million are at risk of developing it, a condition called Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) is becoming a rising concern. About half of the diabetic population may have MAFLD, yet it often goes unnoticed and untreated.
To address this, Dr Mohan’s Diabetes Specialities Centre and the Madras Diabetes Research Foundation have set up a “Diabetes Liver Clinic” in Chennai.
This new clinic aims to catch MAFLD early, improve treatment, and advance research to better understand and fight this liver disease among diabetics.
Inauguration of the Diabetes Liver Clinic. (Supplied)
Addressing the media after the launch of the clinic, Dr V Mohan, Chairman of Dr Mohan’s Diabetes Specialties Centre and Madras Diabetes Research Foundation, said, “Typically, when we consider diabetes, we examine its link to coronary artery disease (CAD), peripheral vascular disease (PVD), retinopathy, nephropathy, and neuropathy — all of which have been substantiated through numerous studies we’ve conducted. However, the significant and escalating concern of MAFLD in diabetic patients often goes under-discussed.”
He added, “It’s clear that the liver is a crucial organ that demands our attention. Transitioning from focusing solely on diabetes to a broader metabolic care approach is critical.”
Dr V Mohan, who topped the Stanford University Global Ranking in the field of Endocrinology and Metabolism for the second time in a row, said that MAFLD — formerly termed as non-alcoholic fatty liver disease (NAFLD) — is a condition where there is accumulation of excess fat in the liver of people who drink little to no alcohol.
Research, even in India, has shown that this is closely linked to metabolic disorders, including obesity, type 2 diabetes, high blood pressure, and dyslipidemia (abnormal levels of cholesterol or fats in the blood).
This condition has significant health implications because it can progress to more severe liver diseases, such as non-alcoholic steatohepatitis (NASH), liver fibrosis, cirrhosis, and even liver cancer.
MAFLD is becoming increasingly common, mirroring the global rise in metabolic disorders, and is a major cause of liver disease worldwide.
Citing a study done by him and his team in Chennai, Dr Mohan said, “The study, done in 2009, showed that NAFLD is present in a third of urban Asian Indians and its prevalence increases with increasing severity of glucose intolerance and in metabolic syndromes.”
Another study in 2019 showed that about 55 percent of those with diabetes had NAFLD and it was 72 percent in subjects with diabetes and obesity. “This basically means that in every two diabetics, one has fatty liver. Of them, 25 percent showed advanced fatty liver (NASH) and others had liver cancer too.”
Screening is essential as MAFLD often progresses silently, with many patients asymptomatic despite significant liver pathology.
Identifying MAFLD early in diabetic patients through regular liver function tests, imaging, and risk stratification is key. It enables the implementation of targeted interventions, such as lifestyle modifications, tighter glycemic control, and possibly pharmacotherapy aimed at the underlying metabolic derangements, to prevent progression to more severe liver disease.
Dr Aswin S Krishna, Hepatologist at the newly-opened Diabetic Liver Clinic, spoke about the importance of screening the liver in patients with diabetes at the launch.
Speaking about the high prevalence of MAFLD cases across the country, especially in Tamil Nadu, he said that this condition is classified into four stages.
With the help of FibroScan, a non-invasive, reliable method for assessing liver stiffness and fibrosis, the patients’ liver condition will be classified into stage 1, 2, 3, and 4.
It offers a safer and less uncomfortable alternative to liver biopsy, he said, allowing for early detection of liver damage that might not be apparent through symptoms or standard blood tests.
“As a tool for monitoring disease progression, FibroScan enables clinicians to measure the effectiveness of treatments and lifestyle changes over time, helping to adjust patient management plans accordingly. Furthermore, it assists in risk stratification, guiding the urgency of clinical interventions,” Dr Mohan explained.
Stage 1, which is simple fatty liver or steatosis, can occur when the liver cells start to build up fat; there is no scarring of the liver at this stage. It is important to know that there are no symptoms either at this stage.
Stages of MAFLD. (South First)
With regular screenings for diabetics, MALFD can be spotted in stage 1 and immediate action can be taken to treat the condition — before it progresses to the next stage — by lifestyle modifications.
Dr Mohan further said, as part of their research at the Madras Diabetes Research Foundation, the clinic will also aim to collect data on alcoholic fatty liver disease.
They will even provide population based normative data on the various novel liver function markers in men and women of different age groups in India.
“There are no markers as to who should be screened for fatty liver, exactly what kind of lifestyle changes need to be done, a normal value to identify different stages of the MAFLD, how long it will take in diabetics to progress from one stage to another — all this will be studied at the centre. In few months time, the research data will be published,” Dr Mohan said.
At the Diabetes Liver Clinic, the doctors claim that fatty liver can be easily reversed with a 52-week lifestyle intervention plan.
Dr Aswin Krishna says, “In people diagnosed with stage 1 and 2 MALFD, the reversal is possible with some specific dietary changes and exercises. In stage 3, there is persistent scarring of the tissue and the blood vessels around the liver but even at this stage, the liver can still function. But without care, it can very quickly lead to cirrhosis too.”
Stage of liver damage and their reversibility. (Health Central)
Describing aspects of lifestyle intervention, which will be prescribed at the clinic, Dr Aswin says, “People diagnosed with stage 1 of MALFD must avoid all transfats, like hydrogenated vegetable oils, fast food, cakes/pastries, chocolate, deep fried food, and also avoid saturated fats like coconut, condensed milk, creamer, poultry skin, fatty meat, butter, ghee, full cream diary products, etc.”
He further recommends the use of unsaturated fats like corn oil, soybean oil, sunflower oil, seeds, cold-water fish, olive oil, canola oil, peanut oil, sesame oil, avocado, most nuts, etc. “They should also avoid fructose-containing foods and must regularly exercise,” he added.
Dr Mohan said that at the Diabetes Liver Clinic, experts will determine the extent of MAFLD and alcoholic fatty liver diseases in those with diabetes, they will try to reverse fatty liver in people with diabetes and obesity, attempt to reverse type 2 diabetes, prevent the progression of fatty liver to cirrhosis and carcinoma.
Answering a question by South First on whether there is any data on children with fatty liver, Dr Mohan said, “When researchers from the Madras Diabetes Research Foundation had visited schools many years ago, very few of them had diabetes and only about 12 percent of them had pre-diabetes. But after 12 years, when the researchers visited the same school, they found that there were several children with pre-diabetes and obesity.”
“The rising number of obesity cases among children due to their lifestyle and dietary habits definitely makes them vulnerable to fatty liver. If at 15 they are diagnosed with fatty liver, by the time they hit their 30s, they might not only be diabetic but may also have MAFLD,” said Dr Mohan.
In terms of diagnosis of fatty liver in children, Dr Mohan said that though there is no data on how many children have fatty liver, the very measurement of waist size is a good criteria for adults to become alert and manage their child’s lifestyle.
The clinic also aims to collect data in terms of children with fatty liver. Association of environmental factors like air pollution and fatty liver are also going to be studied by the Madras Diabetes Research Foundation.
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