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International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391
Volume 6 Issue 12, December 2017
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
To Identify and Examine the Different Causes of
Liver Disease in Sri Lanka
Fahim Aslam1, Hashan Kulasena2
Abstract: Liver disease is one of the main causes for deaths in Sri Lanka; this is the second most common disease causing deaths in
hospitals in Sri Lanka after the heart disease. Sri Lanka ranks eighty-nine (89) in the world rankings for liver disease causing 3349
deaths according to the data published by the World Health Organization (WHO) for the 2014 calendar year and an average of 15.28
deaths per hundred thousand. The two most common forms of this disease is non-alcoholic fatty liver disease and alcoholic fatty liver
disease. The data collected by the WHO is analyzed and the different causes for the liver disease is identified between the period of 1980-
2010, using the different factors responsible for the cause of the disease data is distinguished. Of the data collected and analyzed most
causes of liver disease in Sri Lanka is due to the non-alcoholic fatty liver disease (NAFLD) or alcoholic fatty liver disease which leads to
severe complications such as renal failure, liver cirrhosis and eventually death.
1. Introduction
Liver disease is one of the most prominent disease which
causes millions of deaths around the world. Sri Lanka has
shown vast number of cases develop over the past decades in
which the disease has caused several deaths among people,
the most common types being non-alcoholic fatty liver
disease, alcoholic fatty liver disease, hepatitis A, herbal
medicine and toxins and liver disease due to dengue
infection (Wijewantha, 2017). According to the data
published by the WHO in 2010 for the number of deaths
caused by liver disease caused by intake of alcohol is 57%
for males among a hundred thousand and 37.7% in females,
this percentage highlights the main cause of alcoholic fatty
liver disease which leads to the severe form of liver
cirrhosis.
The number of deaths from liver cirrhosis from different
forms of liver disease has increased severely from 1047 in
1980 to 3415 in 2010, which shows an increase of 330% in
the span of 30 years. Sri Lanka had the second highest
percentage change for liver cirrhosis mortality from 1990 to
2010 where 80.4% increase was visible (Mokdad,2014).
Liver cirrhosis is one of the major problems which has
increased the prevalence of increasing mortality. 20% of the
world population are suffered by the NAFLD and 10% of
the population causes AFLD.
Non-Alcoholic Fatty Liver Disease (NAFLD)
This is one of the common forms of liver disease in Sri
Lanka, where extra fat builds up on the liver cells found in
the liver. The most common causes of this disease is the
people being obese, overweight or diabetes patients. The
disease develops in four main stages, hepatic steatosis in
which fat begins to build in small amounts; this initially
leads to obesity and type 2 diabetes commonly in the
patients suffering (Richard and Lingvay, 2011). Sri Lanka
has shown high number of reported cases of diabetes over
the decades among adults and recently onwards in teenagers
as well. According to the DASL (Diabetes Association of Sri
Lanka) the diabetes type 2 prevalence has been figured
around 20% in Sri Lanka by 2014 and the most recent
studies carried by the WHO has shown mortality rate by
diabetes in Sri Lanka has risen to 7%, obesity and diabetes
contribute to 14.7% in the people (WHO, 2016).
The linkage between the hepatic steatosis and prevalence of
diabetes and obesity in Sri Lanka shows a correlation in the
results and the studies carried out around the country. This
also shows that the linkage between the high mortality rates
due to diabetes and rise in cardiovascular diseases such as
atherosclerosis also has the fat deposition playing a part in
the primary stages of NAFLD and provides evidence that the
increase number of causes signifies interests from various
parts of the body.
The secondary stage of NAFLD is the NASH (Non-
alcoholic steatohepatitis), this is a more severe form of the
liver disease caused in which liver inflammation takes place
and causes the damage to the liver cells present in the liver,
the most common symptoms to lead to these complications
are obesity, type 2 diabetes and metabolic syndrome onset
inside the body. A study carried out by Kasturiratne on the
“influence of non-alcoholic fatty liver disease on the
development of diabetes mellitus” found out that out of the
926 patients who were diagnosed with having NAFLD, 676
patients had diabetes mellitus as the most common cause
(Kasturiratne, 2013).
The third stage of the disease is known as fibrosis in which
the tissues begin to scar the liver tissues and blood vessels
present around the liver, the liver function is not severely
affected by this since the cells have enough amount of
energy and resources for them to function. The final stage
and the most severe stage is cirrhosis in which the liver
tissue will begin to become absent and lot of fibrosis tissues
being to settle on the liver. The structure of the liver begins
to change in the process causing the functions to slow down,
this could lead to liver failure inside the body.
In Sri Lanka one study was conducted in the Nuwara Eliya
district by a team of scientists of the prevalence of NAFLD
among the population. 35-64 years old residence took part in
the study in which 18% of the population among 403 had
NAFLD which was a large percentage among the small
population of people. The most common causes identified
and examined for these causes were gender, high BMI, high
blood glucose and blood pressure. The study identified that
the metabolic syndrome and the economic status also played
a part in which different types of junk food containing fats
and oils contributed in the prevalence of the disease
(Pinidiyapathirage et al., 2011).
Paper ID: ART20178732
DOI: 10.21275/ART20178732
608
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391
Volume 6 Issue 12, December 2017
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
The number of deaths due to cirrhosis has risen drastically
from 1990 to 2010 where 3415 deaths had occurred in which
data for NAFLD and AFLD have not been categorized
separately.
Alcoholic Fatty Liver Disease (AFLD)
AFLD is another prominent form of liver disease that causes
many deaths in Sri Lanka; this liver disease involves the
consumption of alcohol which makes the liver accumulate
fat in the liver cells present. Consumption of alcohol over a
period of time can cause the liver to prevent regeneration of
new cells, the chemicals and toxins present in alcohol
prevents the filtration process in the liver taking place
properly and slows down the regulation of blood sugar and
cholesterol levels as the functions of the liver begin to slow
down and eventually stop it. The three main types of the
disease are fatty liver, which is also known as steatosis just
like the primary stage in NAFLD where fat cells begin to
accumulate in the liver. According to a research carried out
globally the prevalence of steatosis in drinkers were found,
46.4% of heavy drinkers developed steatosis and obesity
was common in 94.5% of them (Bellentani, 2017).
The secondary stage is alcoholic hepatitis where the
inflammation of the liver takes place and liver cells begin to
destroy inside the body. This can be mild as well as in
severe forms inside the body depending on the damage done
by the intake of the alcohol over a period and the quantity
taken. According to the WHO data published for 1961-2010
in Sri Lanka an average of 7.3 liters of alcohol have been
consumed by males and 0.3 for females on average which is
higher than the average for South-East Asia on 3.5. On
average 20.1 liters of alcohol were consumed by the people
of both sexes according to the WHO report. (WHO, 2014).
The last stage of the disease is when the liver cirrhosis takes
place, the liver is severely damaged during this stage and
immediately preventing consumption of alcohol during this
stage can cause life expectancy to increase. According to the
age standardized death rates (ASDR) and positive
correlation factor with alcohol attributable fractions (AAF)
for males 37.3 ASDR there is a 57% AAF which shows
alcohol contributes most deaths in the severe form of liver
cirrhosis in males and in females for 5.3% ASDR there is a
37.7% positive correlation. This data summed up and
analyzed Sri Lanka is ranked 4 out of 5 for the number of
years lost, higher ranking more the years lost in life (WHO,
2014).
The prevalence of cirrhosis can cause other complications
such as accumulation of the fluid in the abdomen and
bleeding from the veins, these can lead to problems such
respiratory tract infections and renal failure resulting from
the liver failure inside the body.
Liver Disease caused by Dengue Infection
Dengue virus infection has been a major threat to Sri Lanka
causing severe illness and infection in the country, a
reported 95344 cases are filed over the seven-month period.
Dengue infection can also be a factor in causing the liver
disease in many ways. Dengue disease is spread by the
vector carrying the disease, Aedes mosquito.
Dengue virus has four main serotypes in which the disease
can be caused DENV 1-4, liver is the main organ which gets
involved due to the virus function, the hepatocytes and
Kupffer cells found in the liver are the main targets for the
dengue infection (Samantha and Sharma, 2015). The DENV
binds with the hepatocytes and leads to the cell death
eventually by apoptosis, this leads to the cells destroying and
necrosis in the liver, the enlargement of the liver takes place
and leads to most severe form of liver failure in children
than adults.
The levels of AST and ALT increases in the liver after the
onset of the dengue fever which then develops into dengue
hemorrhagic fever and then finally to dengue shock
syndrome in the patient. A research carried out by Samitha
Fernando and his team of researchers tested for the liver
functional tests values in 55 patients affected by the dengue
infection. 22 patients had severe dengue infections and 33
had non severe dengue infections, AST and ALT levels were
on the rise in the patients who had severe dengue infection
and this showed that the liver had an injury or damage that
caused the AST and ALT levels to elevate inside the body.
The significance of liver damage causing death in patients
cannot be underlining since there is elevation in liver
enzymes during the infection illness period. Although no
data is available for link between liver disease caused by
dengue infection, there is a link in the dengue infection
being one of the main contributors of the disease in Sri
Lanka with the rising amount of cases and more painkillers
taken which increases the toxic substance found inside the
body (Fernando et al., 2016).
The main causes of the liver disease in Sri Lanka are as
mentioned above, in this article the prevalence of these
diseases and the causes among the population is examined
and using the data available for the disease the different
trends in the change in patterns of the liver disease is
identified.
2. Materials and Methods
Statistical data analysis of the data collected by various
journals and WHO on liver disease in Sri Lanka from the
period of 1980-2010. The main set of was obtained from a
research article published by Ali Mokdad and his team of
researchers (Mokdad et al., 2014). The data obtained from
the different countries ministry, registration and verbal
autopsy on cirrhosis were recorded over a period of three
years for the analysis of data for 30 years.
The study was approved by the World Health Organization
(WHO) and under the regulation of the International
Classification of Diseases (ICD) manual. External data
resources for Sri Lanka was obtained using journal data
published by Hasitha Wijewantha article on the different
types of liver disease (Wijewantha, 2017) and WHO data
release for the period of 1961-2010 in Sri Lanka (WHO,
2014).
Measurements
The number of deaths caused by liver cirrhosis is examined
in the process of different liver diseases, the most severe
form of liver disease also known as cirrhosis causes and the
Paper ID: ART20178732
DOI: 10.21275/ART20178732
609
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391
Volume 6 Issue 12, December 2017
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
reasons for the death to occur is checked with and against
the data on alcohol attribution factors and non-alcoholic
attribution factors responsible in the process.
Using resources from researches carried out on the different
diseases and the causes for these liver diseases to occur the
statistical analysis for each main disease is carried out. The
population, gender and type of habits such as alcoholic, non-
alcoholic or drug abuse patients are examined and fit into
different diseases. Using these data, the most common types
of liver disease in Sri Lanka are examined and checked for a
period of thirty years and the differential causes for this
occurrence is measured.
3. Results
Table 1: The prevalence of alcoholic effects on causing
alcoholic disease is examined in the below table with the
amount of alcohol consumed and the death rates and alcohol
contribution factors for the deaths to occur (WHO, 2014)
Alcoholic Disease Males Females
1. Average Consumption in liters 7.3 0.3
2. Liver Cirrhosis Death Rate (%) 37.3 5.3
3. Alcohol Attributable Factors (%) 57 37.7
Table 2: Factors that influence the non-alcoholic fatty liver
disease (NAFLD) and the difference between the genders
(WHO, 2016)
Non-Alcoholic Disease Males Females
1. Diabetes Prevalence (%) 7.3 8.4
2. Deaths due to diabetes 36.6% 35.7%
3. Deaths due to high blood glucose 59.9% 55.3%
4. Obesity (%) 3.5 10.0
Table 3: Reported Number of Dengue cases over the period
of 2010-2017 and the link between the liver disease rate and
dengue prevalence (epid.gov.lk, 2017)
Year Number of Reported Dengue Cases
2010 34188
2011 28473
2012 44461
2013 32063
2014 47502
2015 29777
2016 55150
2017* 97125
*The data for the year 2017 published is for the period of
seven months
Table 4: The data set for the three decades for the liver
cirrhosis mortality at 95% confidence level is mentioned in
the below table, the upward trend of the results are visible
for the increasing significance of liver disease (Mokdad et
al., 2014)
Year Number of deaths caused by Liver Cirrhosis
1980 1047
1990 1123
2000 2942
2010 3435
Figure 1: Liver Cirrhosis in Sri Lanka 1980-2010 (Mokdad et al., 2014)
The above figure 1 shows the upward trend of the Liver
Cirrhosis mortality in Sri Lanka, the vast peak is observed
from 1990 to 2000 where the reported number of deaths
have doubled (Table 4: Liver Cirrhosis for three decades).
The different causes and the modernization in the country
with the trends in the 21st Century is one of the major
reasons for the sudden rapid changes.
Paper ID: ART20178732
DOI: 10.21275/ART20178732
610
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391
Volume 6 Issue 12, December 2017
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
Figure 2: Liver Cirrhosis in Males, the 57% who consumes
alcohol results in 37% of the death caused by the alcohol
consumed. The other 6% die of reasons not related to
alcohol consumption (WHO, 2014).
Figure 3: Females show a lower death chances due to
alcohol causing liver cirrhosis in which only 5% contributes
to the death rate caused by Liver cirrhosis in the patients and
57% are other reasons which cause the death due to Liver
cirrhosis (WHO, 2014).
Males and females are both prone to get deaths caused by
alcoholic liver disease which goes into the severe form of
liver cirrhosis. Females have a relatively lower chance of
dying due to liver cirrhosis caused by alcohol as figure 3
mentions the proportion contributing to alcoholic liver
cirrhosis that leads to death is only 5% in the females.
This is a complete contradiction to the males since out of the
57% alcohol contribution, 37% is responsible to cause liver
cirrhosis that leads to death. The other factors not related to
liver cirrhosis deaths due to alcohol is only 6%, this shows
that alcohol high consumption my males is a major cause to
direct death by liver cirrhosis.
Figure 4: The death rate due to diabetes and high blood
glucose levels are 97% in males suffering from the disease
in Sri Lanka, 3% of these males end up being obese after
severely affected by diabetes. Only 7.3% of the male
population has diabetes (WHO, 2016).
Figure 5: In females the death rates are lower than in males,
this change after menopause in females which causes the
glucose imbalance to take place. 8.4% of the population in
females (WHO, 2016).
Alcohol consumption plays a bigger part in males than in
females since the consumption amounts by males are much
higher than females (Table 1: Average consumption in males
is 7.3 and females are 0.3). This can lead to high chances of
the liver cirrhosis causing death in the patients.
Diabetes and obesity also influences the NAFLD chances
causing liver disease since one in eleven people in Sri Lanka
are affected by the diabetes there are high chances of the
body being accumulated with glucose and causing hepatic
steatosis. Males have a high death rate due to high blood
glucose which is another factor in which glucose is
deposited onto the liver. Females have higher chances of
being obese than the males in diabetes or high blood glucose
conditions inside the body (Table 2: NAFLD and associating
factors).
4. Discussion
NAFLD, Alcoholic liver disease and liver disease caused by
dengue infection are three major types of infections that lead
to liver cirrhosis; an estimated fifty million people around
the world are suffering from chronic liver disease. The
consumption of alcohol in individual’s results in 9.5% of the
liver disease around the globe and prevalence of NASH in
NAFLD has grown from 6% to 35% by the end of 2015.
According to the data published by Jurgen Rehm in the
article of “Global burden of alcoholic liver diseases” a
reported 493300 deaths were caused due to liver cirrhosis in
2010 representing 0.9% of the global deaths. Alcohol
induced liver disease was only responsible for 80600 deaths
and the rest being other factors such as NASH, NAFLD,
hepatitis and other causes (Rehm et al., 2013). Globally the
rises of deaths due to liver disease have been under the
watch with continuous increase in the number of cases of the
disease being spread around the globe. In Asia 15-30% of
the general population are suffering from NAFLD according
to a research carried out by scientist Wong, (Wong,2012) in
which 50% of them are suffering from liver cirrhosis in the
body.
Paper ID: ART20178732
DOI: 10.21275/ART20178732
611
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391
Volume 6 Issue 12, December 2017
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
In Sri Lanka the rise of liver cirrhosis has increased
considerably over the past three decades, (Table 4: Mortality
Rate of liver disease over the past three decades). The
average percentage for alcohol attributable deaths in South-
East Asia region lies at 12.6% for women and 16.2% for
men whereas in Sri Lanka males have 57% attributable
deaths due to alcohol and females have 38%. This is
relatively a high percentage compared to the other South
East-Asian countries and shows have an overall growth of
80.4% in the mortality rate due to liver cirrhosis, alcohol
related liver disease shows a vast climb due to the high
contribution of alcohol in the cause of liver disease (Rehm et
al., 2013). Patients suffering from alcoholic liver disease end
up losing a lot of years in their life in which the average for
South East-Asia lies on 14.6% of the age lost and in Sri
Lanka the age lost according to the WHO statistics from
2010 is 19.4% for the population in Sri Lanka (WHO, 2014).
Alcoholic liver disease is evident to be one of the major
causes of liver disease in Sri Lanka and has a major
contribution in the disease to develop into liver cirrhosis
which can lead to death in the patients; this is due to several
reasons among Sri Lankan population. Sri Lankan made
alcoholic beverages are the most common form of
purchasing to be made in the country where people are able
to consume more alcohol at a cheaper cost and the quality
standards of the alcohol produced in the country have
resulted in many deaths due to high toxicity. An example of
this is the amount of alcohol consumed in Sri Lanka for the
year 2010 where males have an average of 7.3 liters of legal
alcohol being consumed according to the WHO report for
Sri Lanka for the year 2010, and Sri Lanka ranks number
one for the most amount of alcohol consumed liters per
capita at 16.79 liters. The most common drink to be
consumed is arrack in Sri Lanka where 75.25 liters on
average were consumed which was 86% of the major source
(Sundaytimes.lk, 2012). This also has influenced in Sri
Lanka being the second highest death rate for liver cirrhosis
at 55 deaths per hundred thousand only next to Moldova.
The consumption of arrack causes the fat deposition to
increase over the time in the body and results in the toxicity
released by the arrack produced, the liver is unable to deal
with the toxic substance eventually leading to the liver
failing. Arrack consumption is more prominent in low
income families of the urban region where they consume
arrack at a larger scale (Katulanda et al., 2014). The main
reasons for consuming alcohol in Sri Lanka were for
tiredness, joy, sorrow and for courage; this makes people
drink high amounts of alcohol making the body fight with
high toxic levels in the liver. The liver is unable to neutralize
and excrete these toxic products inside the body resulting in
the disturbance in both the mental and physical health, due
to alcoholism many road traffic accidents, violence, sexual
abuse and other diseases also happen.
The main reasons for the country of 20 million people to be
ranked number one in the most amount of alcohol consumed
is mainly the income levels of the people where most people
with lower income prefer intake of high toxic drinks such as
toddy and arrack which are cheap to purchase and the levels
of toxicity is also high. The other reason is no health policy
is developed in the country for the drinkers and no national
plans are available in the country to minimize the alcohol
consumption (WHO, 2014). There is no restriction for how
many hours the stores selling alcohol can function in the
country unlike countries like USA where policies are
designed to increase and reduce sale hours during different
times of the seasons (Hahn et al., 2010). There is no
restriction in selling alcohol for the people who have been
already intoxicated and under severe disease control this
makes the people who have been already intoxicated to be
able to consume more alcohol over the period of time in the
country without any ban imposed on them. No regulations
and health warnings are placed on the alcohol being sold and
no advertising is carried out on the sale of alcohol in the
country allowing people to be less aware of the disease
caused in the country and the implications caused by it
(WHO, 2014).
NAFLD on the other hand has been one of the major issues
surrounding the world since 20% of the world population are
suffering from NAFLD and most of these people are
affected with obesity and diabetes in common. Sri Lanka
have a high rate of people with diabetes and obesity making
them prone to get NAFLD. No proper study among a large
population is not carried out to analyze the effect of diabetes
and obesity linked up with NAFLD. A study carried out by
Pinidiyapathirage in 2011 identified the NAFLD among the
population living in Nuwara Eliya where the population was
checked for being obese and having a high BMI in them
causing the NAFLD to be present in 18% in the checked
population (Pinidiyapathirage et al., 2011).
Sri Lanka has a high rate of prevalence of diabetes in the
world, where Sri Lanka ranks 31 out of the world for the
number of death rates per hundred thousand where Sri
Lanka stands at 47.87. According to a research carried out
by Katulanda, the Sri Lankan Tamil and Moor ethnicity had
the highest rate of diabetes present in them (Katulanda et al.,
2011). Diabetes causes 7% of the mortality among Sri
Lankan population and causes nearly 10000 deaths every
year. The patients suffering or recovered from diabetes are
either with high blood glucose, which results in around
15000 deaths (Table 2: Factors influencing non-alcoholic
fatty liver disease). This population is obese, overweight,
physically inactive or diabetes prone patients.
The link between NAFLD and diabetes patients are that
patients with NAFLD have extra fat deposits on the liver
cells causing it to go into NASH and eventually cirrhosis in
the patients. Sri Lanka has shown an inclined rate of liver
cirrhosis ranking second in the world behind Moldova where
the alcoholic factors contribute to around 50% of the causes
for the disease. The other 50% lies among the other liver
diseases and NAFLD is one them. In Sri Lanka the urban
population suffers from 32.6% NAFLD and 18% suffers in
the rural area (Kodisinghe and Niriella, 2015). According to
the World Gastroenterology Organization, NAFLD and
NASH are the main causes for advanced liver disease and
mortality around the world (Sherif, 2016) and the main
causes for this to happen have been identified as diabetes,
obesity and metabolic syndrome disorders.
Adolescents are more viable to get these diseases and in Sri
Lanka in a survey carried out this was proven when out of
Paper ID: ART20178732
DOI: 10.21275/ART20178732
612
International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391
Volume 6 Issue 12, December 2017
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
the 508 adolescents involved 44 of them had NAFLD with
obesity, high waist and elevated blood pressure visible
(Rajindrajith et al., 2015). Sri Lanka has a high proportion of
obese people and diabetes people where around 6.8% of the
Sri Lankan suffer from obesity and 26.1% are overweight.
No health polices and strategies available in the country has
made the prevalence of the disease to be at its peak in Sri
Lanka since the number of diabetes cases have increased
gradually and the number of cases reporting from NAFLD
also have increased since the rate of liver cirrhosis have
increased significantly. No diabetes registry is maintained to
identify the number of deaths caused due to various reasons
in the people and no proper medications are available on
hand as primary facilities for the people suffering from the
disease to minimize the effect such as the availability of
insulin as the primary healthcare facility (WHO, 2016).
The growth of NAFLD cases and NASH cases are also due
to the food intake and the amount of physical activity taken
by the people, out of the 20 million Sri Lankan populations
present 23.7% of them are physically inactive causing
diseases such as artherosceloris and respiratory tract
infections to develop. The food containing high sugar levels
can result in high blood glucose in the patients and the
chances of developing diabetes in them. The modern era of
fast food influences most the causes of NAFLD due to the
food containing high levels of fat and oils and deposits
inside the body in excess causing various diseases to be
formed. According to a journal published by Yasutake the
dietary habits, lifestyle and the therapeutic approach carried
out for the NAFLD patients influences the significance of
the stages development of the NAFLD. Low calorie diet and
exercise are examples of things that need to be followed to
prevent from being affected by NAFLD (Yasutake et al.,
2014).
The high rates of death due to cardiovascular diseases also
can be influenced by the NAFLD since it could lead to
diabetes as well in the people. The type 2 diabetes and
coronary heart disease are the most common forms of the
diseases to be formed and this does not contain data in Sri
Lanka to analyze and distinguish between cases formed due
to NAFLD. Lack of data available to analyze the different
causes produced by the NAFLD and the complications that
can rise due to it cannot be discussed due to limited
information available on the disease in Sri Lanka.
The most common causes of the liver disease in Sri Lanka
are most likely to be NAFLD and AFLD in the patients who
die due to liver cirrhosis since most the factors and data
collected are within the parameters of the results obtained.
There are other diseases and causes as well which can cause
the liver cirrhosis to take place such as the dengue infection
which can lead to liver damage where the viral toxicity and
the apoptosis of hepatocytes in the liver. With Sri Lanka
having increased cases of dengue fever cases the chances of
liver cirrhosis also can increase and become significant in
the near future if no treatment for dengue is discovered
(Samantha and Sharma, 2015). Another disease that can
cause the increased chances of liver cirrhosis is viral
hepatitis which can cause viral replication that can result in
the hepatocytes to produce more proteins of the viruses and
cause severe damage to the liver (Nakamoto and Kaneko,
2003). Hepatocellular carcinoma is another disease which is
not that evident of causing liver disease in Sri Lanka but is
one of the most common forms of cancer present in the
world. In Sri Lanka a 105-reported cases were found in 2011
in the North Colombo Liver Unit, although the disease data
is not available there are chances of the data of HCC to be
presented in the coming years causing liver cirrhosis
(Siriwardana et al., 2013).
Liver cirrhosis is a growing cause present in Sri Lanka and
has shown a significant rise from 1990 to 2010 where the
reported number of deaths have increased by 80.4% in the
country and the data not measured properly by the Sri
Lankan Health databases. There are several limitations
regarding the type of liver disease causing liver cirrhosis
since the data collected was analyzed using various sources
in which the liver disease was examined and analyzed. The
cause of death due to liver cirrhosis and the main reasons
behind the cause of it happening cannot be identified
accurately since various diseases resembles the cirrhosis to
occur such as NAFLD and AFLD the exact cause for the
cirrhosis of the patients cannot be known without the data
for the different diseases. No documentation of the results
and the liver disease after 2014 found to be available where
only small researches were carried out over time to identify
the widespread of the disease present therefore the
prediction of the liver disease from 2014 is unknown.
Various other reasons excluded in which liver cirrhosis can
take place such as hepatitis and HCC are the two most
common forms present in the world in which can cause liver
cirrhosis at a large scale. Data obtained based on hospital
records of people registered for the treatment and the people
with the severe forms of liver disease only, this could limit
the findings for the preliminary stages of NAFLD and
AFLD since the records are only available for the cirrhosis
state.
5. Conclusion
In study the project identifies the different types of liver
disease and the main factors that influence them. The most
common types of liver diseases are identified as NAFLD
and AFLD which causes the most severe form of liver
cirrhosis in patients. The main factors that influences
NAFLD is diabetes and obesity and for AFLD is the
consumption of alcohol. Males are the most affected in
AFLD and females and males have almost equal effects in
NAFLD. To reduce the number of liver cirrhosis cases the
NAFLD and AFLD needs to be diagnosed at earliest stages
of the disease and record the data to ensure that the other
population does not go into the same trend of suffering. Sri
Lanka is ranked second for the most number of deaths due to
liver cirrhosis and ranked number one in the consumption of
alcoholic beverages in the country, this has been progressing
over the years where 80.4% increased deaths from 1990 to
2010 was observed. Future action needs to be taken to
ensure the alcohol consumption is reduced and health
policies are implemented to reduce cases of diabetes and
alcoholism in Sri Lanka.
6. Abbreviations
NAFLD, non-alcoholic fatty liver disease; AFLD, alcoholic
fatty liver disease; WHO, World Health Organization; BMI,
Paper ID: ART20178732
DOI: 10.21275/ART20178732
613
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ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391
Volume 6 Issue 12, December 2017
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Licensed Under Creative Commons Attribution CC BY
body mass index; DASL, Diabetes Association of Sri Lanka;
NASH, non-alcoholic steatohepatitis; ASDR, age
standardized death rates; AAF, alcohol attributable fractions;
DENV, dengue virus; AST, aspartate transaminase; ALT,
alanine transaminase; ICD, International Classification of
Diseases; HCC, hepatocellular carcinoma.
7. Statement of Declaration
I would like state that all my work on the project report was
carried out with honesty and all external source of data used
have been referenced properly in the Harvard Referencing
Style format. The project document has not been used by
any other personal or shared, the soft copy is attached as a
PDF file document in the CD-ROM attached with the
project. I am aware of the guidelines, regulations and
policies of the BCAS CITY CAMPUS and the disciplinary
guidelines and penalties to be applied if I breach them.
8. Acknowledgement
I would like to thank my lecturer, Dr. Hashan Kulasena for
providing valuable feedbacks and opinions and insights to
the project which made it possible for me to complete the
project on time. I would also like to thank my seniors and
batch members for providing their valuable support for me
to complete the project.
Thank you.
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Volume 6 Issue 12, December 2017
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