By Patricia B. Mirasol, Reporter 

TO AVOID liver cancer, individuals who are overweight, diabetic, or hypertensive should strive to lose enough pounds to stay within the healthy range, get vaccinated against hepatitis B, and drink alcohol in moderation (or skip it altogether). 

These lifestyle changes can help prevent fatty liver disease, “the fastest rising cause” of liver cancer (also known as hepatocellular carcinoma or HCC) worldwide, according to several studies. 

“There’s no safety limits of alcohol, to reiterate our stand,” said Dr. Diana Alcantara-Payawal, president of the Philippine College of Physicians and regional representative of the Global Liver Institute, meaning that the safest number of drinks is zero. 

“When you gain weight in the middle … there’s also more susceptibility to MAFLD, or Metabolic Associated Fatty Liver Disease,” she said at a June 16 webinar by the Hepatology Society of the Philippines.  

MAFLD, previously known as non-alcoholic fatty liver disease, is a condition characterized by a build-up of fat in the liver.  

Fatty liver disease refers to a range of liver disorders not caused by alcohol consumption, autoimmune disease, drug use, or viruses. At least 18 million Filipinos are either suffering from or at risk of it.  

Even those with normal weight — or a body mass index of less than or equal to 23 kg/m3 in Asians — are at risk of the disease if at least two other factors are present. These include: having a waist circumference of more than or equal to 90 centimeters for Asian men, or more than or equal to 80 centimeters for Asian women, as well as high blood pressure of more than or equal to 130/85 mmHg.  

A 2018 study co-authored by Dr. Payawal on the 2003-2018 etiology of HCC in the Philippines found that liver cancer due to hepatitis B has been on a downward trend through the years, thanks to hepatitis B vaccination. On the rise, however, are both non-alcoholic and alcoholic fatty liver disease.  

“We can see this to be an increasing trend as far as the etiology of liver cancer, from a communicable disease because of hepatitis B, to a non-communicable one,” said Dr. Payawal.  

This growing MAFLD trend also extends to the Asia Pacific, including countries like Taiwan and Malaysia, “because of the increasing trend of rapid urbanization [that has led to] less exercise,” she added.  

While a normal liver has less than 5% hepatic fat, a buildup can progress from steatosis (fatty liver without inflammation), steatohepatitis (fatty liver with inflammation), cirrhosis (liver scarring), to HCC (the most common primary liver cancer that occurs in people with chronic liver disease).  

An absence of cirrhosis is reported in 30–50% of Asians with MAFLD-associated HCC, according to Dr. Payawal. Among this group, she added, steatosis can develop straight into HCC or reverse course provided that the patient makes lifestyle changes.    

“The caveat is that there is reversibility in all stages of the disease,” she said. “There is light at the end of the tunnel if you are diagnosed …  There is reversibility all the way to cirrhosis. It is not too late to institute lifestyle intervention, because that is the key to all this,” she said.  

The liver regulates most chemical levels in the blood and excretes a product called bile, which helps carry away waste products from the organ.