sudden death from cirrhosis of the liver sudden death from cirrhosis of the liver

The damage done by cirrhosis typically cannot be undone. 0:00. Generally no. Primary biliary cholangitis (PBC), formerly known as primary biliary cirrhosis, is a disease caused by damage to bile ducts in the liver. Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, (Eds). Fatty liver, alcoholic hepatitis, cirrhosis. The damage leads to scarring, known as fibrosis. People with cirrhosis may also develop liver cancer. The assessment and management of pain in cirrhosis. There may also be a backing up of water in your belly and/or legs. Portal hypertension: This is the most common serious complication. This article may contains scientific references. (Even if you have hepatitis B or fatty liver disease without cirrhosis, you are at increased risk of liver cancer.). High white blood cell count (indicates an infection). Even though not all occurrences are due to alcohol abuse, people with this condition can benefit from avoiding alcohol completely, as experts recommend. This causes a greater sensitivity of the person to the medicines and their side effects. Inflammation is a sign that your bodys immune system is healing up an injury or combating an infection. Physicians use diagnostic tests and scoring to determine a persons stage of cirrhosis, which will help project their life expectancy. For instance, if you have non-alcohol related fatty liver disease and have obesity, you may also have osteoarthritis and cirrhosis makes your bone and joint pain worse. -Low platelet count will be witnessed amongst the patients. You will receive the first liver transplant and decompensated cirrhosis email in your inbox shortly. Giving beta blockers or nitrates to lower blood pressure in your veins. But according to Dr. Wakim-Fleming, women are more sensitive to drug or alcohol-related liver disease than men due in part to their body composition. If you do drink alcohol, limit how much you drink and how often. The National Institute for Diabetes and Digestive and Kidney Diseases state at least 1 in 400 adults in the U.S. has cirrhosis. It also reduces the production of proteins and other substances made by the liver. Excess body fat can damage your liver. It affects about 1 in 200 adults age 45 to 54, the age group most commonly affected by cirrhosis. About 3.5% of cancer deaths worldwide are a result of drinking alcohol. Accessed Jan. 6, 2023. Liver transplantation in adults: Patient selection and pretransplantation evaluation. "Studies have shown that consumption of . It was very suttle. Physicians use CTP and MELD scores for guidance in referrals for liver transplants. That is if none of the complications kill you. Avoid high-risk behaviors that can lead to infection with hepatitis B or C, such as sharing needles for illegal drug use or having unprotected sex. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849403/#:~:text=chronic%20liver%20disease-,Introduction,%5B1%E2%80%A2%E2%80%933%5D. This condition reduces life expectancy drastically. It causes the liver to swell, which can eventually lead to cirrhosis. Over time, the disease keeps the organ from working properly and eventually causes failure. Cirrhosis is the result of long-term, continuous damage to the liver and may be due to many different causes. Higher level of iron (may indicate hemochromatosis). The main causes of 436 deaths among 532 patients with cirrhosis followed up for up to 16 years constituted liver failure (24%), liver failure with gastrointestinal bleeding (13%), gastrointestinal bleeding (14%), primary liver cell carcinoma (4%), other liver-related causes (2%), infections (7%), cardiovascular diseases (22%), extrahepatic (2018). This interferes with the livers ability to function and, Liver failure is when the liver is losing or has lost all of its function. You may opt-out of email communications at any time by clicking on Anyways, if you begin treatment at this stage, your liver still has the chance to heal up over time. U.S. National Library of Medicine/Medline Plus. Patients with irreversible, advanced liver disease and their families live with a complex and challenging condition that follows a highly unpredictable illness trajectory. Gastroenterologist (doctor who specializes in conditions of your digestive tract). Allscripts EPSi. Obesity is another common cause that is on the uprise. As their health deteriorates, patients often experience debilitating symptoms, psychological stress, family worries, financial problems, social stigma, and existential distress. If your doctor finds something suspicious, further blood tests may be necessary. Hepatology. Sadly, some people will never realize they have the liver disease until it reaches the stage of cirrhosis. Cirrhosis of the Liver Cirrhosis is a late-stage liver disease in which healthy liver tissue is replaced with scar tissue and the liver is permanently Portal hypertension is an increase in the pressure in your portal vein (the large blood vessel that carries blood from the digestive organs to the liver). Medical Clinics of North America. This serious condition can be caused by many forms of liver diseases and conditions, such as hepatitis or chronic alcoholism. Elsevier; 2020. https://www.clinicalkey.com. This content does not have an Arabic version. You can easily reverse inflammation. National Institute of Diabetes and Digestive and Kidney Diseases. Health professionals learn more and more every day about the conditions and diseases that damage our livers. The family didn't notice at first but there were some changes in her cognitive thinking. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. (https://www-wjgnet-com.ccmain.ohionet.org/1007-9327/full/v20/i18/5442.htm), (https://www.hepatitis.va.gov/cirrhosis/background/stages.asp), (https://www.statpearls.com/articlelibrary/viewarticle/19569/), Visitation, mask requirements and COVID-19 information, endoscopic retrograde cholangiopancreatography, Yellow tint to your skin or the whites of your eyes (. He died suddenly while out to dinner. If you dont treat inflammation, your inflamed liver would begin to scar. Liver specialists and researchers have developed many different scoring systems to predict outcome and to guide treatment for chronic liver disease. Together, the scarring and the nodules are called cirrhosis. Eat a well-balanced, low-fat diet, such as the. Cirrhosis is usually a result of liver damage from conditions such as hepatitis B or C, or chronic alcohol use. Discussion. Diseases that damage or block bile ducts in the liver (tubes that carry bile from the liver to other parts of digestive system; bile helps digest fats): Primary sclerosing cholangitis (inflammation of the bile ducts leads to scarring and narrowing of the ducts and buildup of bile in the liver). Jaundice: Jaundice occurs when the diseased liver does not remove enough bilirubin from the blood, which causes a yellowing of the skin and the sclera of the eyes, and darkening of the urine. What is it? Injured liver cells are replaced with scar tissue. Fatigue. Maintain a weight that's healthy for you. It is, therefore, very important to begin treating liver disease very early. Nonalcoholic fatty liver disease, a condition in which fat accumulates in the liver. 11 William Ho Author has 268 answers and 766.8K answer views Updated Thu Related What is the life expectancy of an active alcoholic with end-stage/stage four liver cirrhosis? Hepatic fibrosis 2022: Unmet needs and a blueprint for the future. Dietary Dos and Donts for Migraine Sufferers, Shirshasana (Headstand) Versus Inversion Therapy Using Inversion Table, Understanding Joint Pain and Tips to Get Relief Using Home Remedies, Erectile Dysfunction: Does Opioid Cause ED, Libido: Opioid Induced Female Sexual Dysfunction. Aside from being inflamed, your liver may also become enlarged and tender. Any time an organ is injured, it tries to repair itself. Alcoholic liver disease is caused by heavy use of alcohol. 70% of Americans Don't Realize Alcohol is a Major Risk Factor for Cancer . Poorly formed bile ducts, a condition known as biliary atresia. This site complies with the HONcode standard for trustworthy health information: verify here. This can make your abdomen enlarge like a balloon filled with water. Can diet help improve depression symptoms? Even this would require serious management because some of the complications are deadly. Nephrologist (doctor who specializes in conditions of your kidney). Your healthcare provider will first ask about your medical history and over-the-counter and prescription drug use. As cirrhosis gets worse, more and more scar tissue forms, making it difficult for the liver to do its job. Symptoms Signs and symptoms of acute liver failure may include: Yellowing of your skin and eyeballs (jaundice) Pain in your upper right abdomen A swollen belly (ascites) Nausea Vomiting A general sense of feeling unwell (malaise) Disorientation or confusion Sleepiness Breath may have a musty or sweet odor Tremors When to see a doctor Alagille syndrome (born with fewer than normal number of bile ducts; affects bile flow and causes jaundice). Nov. 23, 2022. For women, absence of or loss of periods not related to menopause. Hepatocellular carcinoma has a high mortality rate, but there are several treatment options available. Liver failure: Treatment depends on if you have acute or chronic failure. Sudden death due to undiagnosed liver cirrhosis - anyone go through this? (2018) Clinical Features of Liver Disease. If you'd like to learn even more about cirrhosis, watch our other related videos or visit mayoclinic.org. Your liver may keep working even when you have cirrhosis. This causes a physiopathological mechanism by increasing the pressure in the portal system. When scarring starts to outnumber and overwhelm healthy tissue, the liver begins to fail. This can be a life threatening condition. The more cirrhosis worsens, the more dysfunctional your liver will become. https://www.uptodate.com/contents/search. These conditions are very serious and they are life-threatening. Top Home Remedies for Liver Cirrhosis 1. Another good option is " cruciferous " veggies. Continuing to drink (beer wine whiskey is all ethyl alcohol) will only increase your troubles. 1 When these substances enter the brain, they can cause a neurological condition called hepatic encephalopathy . According to a study published Wednesday in BMJ by Tapper and a colleague, fatal liver disease has risen, and young people have been hit the hardest. If the patient reaches the final stage of liver cirrhosis undiagnosed, there is a resulting increase in the risk of death within 12 months. The cirrhosis death timeline usually ends either at liver failure or liver cancer. And if you dont treat cirrhosis on time, your liver will eventually fail and that is almost certain to cause death. Loss of sexual desire. For chronic liver failure, diet and lifestyle changes include stopping alcohol and medications that harm the liver; eating less red meat, cheese and eggs; losing weight; managing high blood pressure and diabetes and cutting down on salt. Manage Settings HIGHLIGHTS who: Enrico Pompili and MD from the ItalyDepartment of Medical and Surgical Sciences, University of, Italy have published the article: Low hemoglobin level Predicts early hospital readmission in patients with cirrhosis and acute decompensation, in the Journal: (JOURNAL) what: Jo ur n al P re -p Thus, the aim of this study was to Low hemoglobin level predicts early hospital . An example of data being processed may be a unique identifier stored in a cookie. Elsevier; 2021. https://www.clinicalkey.com. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. When the enire liver is scarred, it shrinks and gets hard. This occur when toxins from your intestines arent removed by your damaged liver and circulate in the bloodstream and buildup in your brain (a condition called. Death may be relatively sudden and unexpected. You can learn more about how we ensure our content is accurate and current by reading our. Can poor sleep impact your weight loss goals? Your lab work and imaging findings may not be abnormal. This is the process we call fibrosis. How Cirrhosis Causes Death Cirrhosis of the liver is a disorder in which healthy liver cells are gradually replaced by scar tissue. Histologic scoring systems for chronic liver disease. This liver. Make a donation. Treatment consists of removing the cause of the liver inflammation, which in the case of alcoholics, means abstinence. This is followed by cell repair and finally tissue scarring as a result of the repair process. And if you don't treat cirrhosis on time, your liver will eventually fail and that is almost certain to cause death. There are many complications of cirrhosis of the liver. include protected health information. Stage I: Steatosis The first stage of liver disease is characterized by inflammation of the bile duct or liver. Yes sadly very advanced liver cirrhosis can result in sudden death. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Kidney failure: Treatment may include medication, dialysis and kidney transplant, depending on the cause and extent of failure. During later stages, you might develop jaundice, which is yellowing of the eyes or skin; gastrointestinal bleeding; abdominal swelling from fluid building up in the belly; and confusion or drowsiness. If you are a Mayo Clinic patient, this could (Median is the middle point in set of numbers, so an equal number of individuals survived less than 9 to 12 years as the number of individuals who survived over this time range.). This questionnaire is commonly used in routine health care to detect alcohol beers and dependency and is known by the acronym. health information, we will treat all of that information as protected health Cirrhosis refers to when hard scar tissues have replaced almost all the soft healthy tissues in your liver. By subscribing to decompensated cirrhosis and liver transplant content from Mayo Clinic, you have taken an important first step in gaining knowledge and using it for your overall health and well-being. Cirrhosis and Fibrosis VIDEO Various disorders, drugs, or toxins can repeatedly or continuously damage the liver. Cirrhosis is a common cause of death worldwide. Having cirrhosis means your liver has scar tissue in it because it has been damaged. For instance, treating alcohol addiction, losing weight, and using medications to treat viral hepatitis and other conditions can limit damage to the liver. Find out what the signs and symptoms are and how it can be treated and prevented. Antiviral drugs can prevent additional liver damage due to viral hepatitis. In 2017, 998 men and women aged between 35 and 49 died from liver disease, which represented 10% of all deaths in this age group; greater than deaths from . However, those who drink too much alcohol, those who are overweight and those with viral hepatitis are at a greater risk. You and your healthcare team will work together to closely manage your condition and put you on a wait list for a donor liver. The symptoms, diagnosis and treatment. Jan. 8, 2023. Who gets it? Eat a healthy, well-balanced, low-fat diet, such as the Mediterranean diet. If you don't receive our email within 5 minutes, check your SPAM folder, then contact us at newsletters@mayoclinic.com. Studies of sudden nonviolent deaths illustrate the largely unrecognized and frequent occurrence of sudden death with autopsy findings limited solely to fatty liver. You may not feel it when inflammation affects only a little portion of your liver. 26th ed. Overview of cirrhosis. Medical Videos Privacy Policy, Images and Text Policy Editorial Policy, Information Policy Advertising Policy, Financial Disclosure Policy Cookie Policy, About Us Contact Us. This number could be even higher, as many people do not receive a diagnosis until they develop advanced symptoms. It can be fatal. Enlarged blood vessels are more likely to burst due to thin walls and increased pressure. But if liver cirrhosis is diagnosed early and the underlying cause is treated, further damage can be limited. What are the Symptoms of Ascites in Women? Can Your Liver Regenerate If You Have Cirrhosis? The whites of your eyes are turning yellow. The consent submitted will only be used for data processing originating from this website. Scar tissue keeps your liver from working properly. When cancer starts in the liver, it is called liver cancer. When you have cirrhosis, you may bruise or bleed easily. Definitions & facts for cirrhosis. It is the major cause of liver disease in Western countries. privacy practices. About 10% of heavy drinkers develop cirrhosis, which is the third stage of alcohol-related . Confusion, difficulty thinking, memory loss, personality changes. And even in the most severe cases, liver transplants and new treatments provide those suffering from cirrhosis with hope. Alcohol is what has damaged your liver and caused all the symptoms you have right now. As its name implies, liver failure occurs when your liver isnt working well enough to perform its many functions. Hemorrhages: When the production of proteins necessary for blood coagulation by the liver stops or slows down, the person suffers haemorrhages easily. Learn more about the stages, signs, treatments and more here. Cirrhosis of the liver is one of the final stages of liver disease. Cirrhosis This is a condition that occurs when the liver cells and tissues deteriorate, impacting the function of the organ. If liver damage is caused by a virus, it will eventually cause cirrhosis, except you properly treat it. Clubbing of the fingers, in which the fingertips spread out and become rounder than usual. By the time cirrhosis reaches its end-stage, decompensation has progressed seriously and the damage has become irreversible. Scar tissue keeps your liver from working properly. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. A Mayo Clinic expert explains, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, What is cirrhosis? Scar tissue also partly blocks the flow of blood through your liver. Inherited disorders of sugar metabolism, such as galactosemia or glycogen storage disease. Cirrhosis. When blood flow through veins is partially blocked, veins in your esophagus, stomach or intestines can become enlarged (a condition called varices). But they all have a similar progression regardless of the specific type of liver damage. Each year in the United States, about 25,000 men and 11,000 women get liver cancer, and about 19,000 men and 9,000 women die from the disease. Sometimes, it is your bodys immune system that is damaging your liver. When the damaged tissue accumulates enough to interrupt liver functioning, it puts your health in serious jeopardy. Is exercise more effective than medication for depression and anxiety? Cirrhosis may be caused by excess alcohol intake, hepatitis, nonalcoholic fatty liver disease, bile duct diseases and various hereditary conditions. Compensated cirrhosis: People with compensated cirrhosis do not show symptoms, while life expectancy is around 912 years. Complications of Cirrhosis. The liver damage caused by cirrhosis generally can't be undone. Alcoholic liver disease or alcoholic hepatitis (hepar=liver +itis=inflammation), viral hepatitis (B or C), and fatty liver . Often, cirrhosis shows no signs or symptoms until liver damage is extensive. The initial clinical manifestations of hemoperitoneum include pain and distension with increased abdominal diameter, besides dizziness or syncope. There are many possible causes of liver damage. When this happens, the drugs act for longer than normal and accumulate in the body. The death certificate issued for actress Elizabeth Pea shows "cirrhosis of the liver due to alcohol" as one of the four listed causes of her sudden death last week. Get vaccinated for hepatitis A and B. Their life expectancy is greatly reduced than those with compensated cirrhosis, while experts recommend referral for a possible liver transplant in these cases. But if you dont, it progresses to the next stage in the death timeline fibrosis. Cirrhosis often has no symptoms until liver damage is severe. Facts about . U.S. Department of Veterans Affairs. No disability insurance through employer. As more scar tissues grow, they begin to take the place of normal liver tissue. Blocked bile duct (can cause infections, backup of products in the liver). Decompensated cirrhosis: People with decompensated cirrhosis already experience symptoms and complications. Evaluation and prognosis of patients with cirrhosis. Causes of ascites due to liver problems include: Cirrhosis describes a form of liver disease in which liver tissue that is damaged is replaced by scar tissue. Tips for Recovery from Alcoholic Fatty Liver Disease and Signs Your Liver Is Healing, Best Vegan Meal Plan for Fatty Liver Disease, High Protein Vegan Recipes You Should Try, Bariatric Surgery Diet Pre Op and Post Op: What You Should Know, New Year New Me: How to Strive for Weight Loss, What You Need to Know About High Functioning Depression and How to Manage It. Spontaneous hemoperitoneum secondary to rupture of intraabdominal varices is a serious and often deadly condition. Treatments for the causes of cirrhosis are as follows: Portal hypertension: Portal hypertension is mainly the result of chronic end-stage liver disease. Hepatitis damages the liver, making it less able to move bilirubin into the bile ducts. UpToDate. The cause of death was concluded as hemoperitoneum, due to rupture of mesenteric varices, cirrhosis, due to chronic alcoholism. Early symptoms of cirrhosis may include feeling tired or weak poor appetite losing weight without trying nausea and vomiting mild pain or discomfort in the upper right side of your abdomen As liver function gets worse, you may have other symptoms, including bruising and bleeding easily Your provider may suspect you have cirrhosis if you have a long history of alcohol use, injectable drug use or have had hepatitis B or C and have the symptoms listed in this article. You may have hepatic encephalopathy (HE), a disorder caused by a buildup of toxins in the brain that can happen with advanced liver disease. At that stage, life expectancy is more or less one to 2 years. You are confused, irritable, disoriented, sleepy, forgetful or foggy.. Only 43 percent of patients survive the one-year mark . Our articles are resourced from reputable online pages. information and will only use or disclose that information as set forth in our notice of These small channels carry the digestive fluid, or bile . At this point, death is imminent. He was laughing and joking and got up to go to the bathroom. high blood pressure in the liver, or portal hypertension, which can then lead to enlarged veins and internal bleeding, fluid build-up in the abdomen, swelling in the lower extremities, and difficulty thinking, an abnormal build-up of fluid in the abdomen, and how it responds to treatment, normal levels of albumin, a protein made by the liver, high levels of bilirubin, which could mean the liver is not working properly, normal blood clotting time, or international normalized ratio (INR), creatinine, which can indicate kidney damage, laxatives to help rid the system of toxins, beta-blockers, to reduce portal hypertension, getting treatment for conditions that might have caused cirrhosis, such as hepatitis C or B, getting regular check-ups and prompt treatment for complications, avoiding taking vitamin C, if iron levels are high. Cirrhosis refers to when hard scar tissues have replaced almost all the soft healthy tissues in your liver. 3. This also allows for early intervention and treatment of any complications that may arise. Medications and procedures to treat cirrhosis symptoms include: According to the VA, although cirrhosis is progressive, some people with the condition can move from decompensated, or symptomatic, back to the asymptomatic stage. Liver transplantation may be an option if your liver is failing. Weight loss. Some include inflammation and scarring of the bile ducts, known as primary sclerosing cholangitis; iron buildup in the body - what we call hemochromatosis; copper accumulation in the liver, which is a rare condition called Wilson's disease; and inflammation from the body's own immune system harming liver cells, known as autoimmune hepatitis. Alcoholic liver disease occurs as a result of chronic excessive consumption of alcohol. This content does not have an English version. We do not endorse non-Cleveland Clinic products or services. It could be. It is a serious condition, causing scarring and permanent damage to the liver. If alcoholic hepatitis deteriorates into its most extreme form (liver failure) it can lead to death. A Child-Turcotte-Pugh (CTP) score, also known simply as the Child-Pugh score, is a clinical score that tells your doctors how severe your liver disease is and forecasts your expected survival rate. However, some of the diseases that can cause liver damage that lead to cirrhosis are inherited diseases. Cancer is a disease in which cells in the body grow out of control. Between 10 to 20 percent of heavy drinkers develop cirrhosis typically after 10 or more years of drinking. You may not have symptoms in the beginning stages of the disease. What is Hepatic Encephalopathy and How Does it Develop? Pain in your liver itself can feel like a dull throbbing pain or a stabbing sensation in your right upper abdomen just under your ribs. Acetaminophen can be taken safely at a dose up to 2,000 mg daily. If you drink more than two drinks a day if you are a man or more than one if you are a woman, you are increasing your risk. He or she may refer to you having either compensated cirrhosis or decompensated cirrhosis. Clinical and Molecular Hepatology. The study, based on a retrospective review of the records of 456 patients, found nine patients to have liver . Fluid leaks out into the belly and it begins to fill it up. Depending on the underlying cause, its possible to slow or stop cirrhosis from worsening. Accessed 10/11/2020. If you have cirrhosis and experience the following, call 911: Depending on the stage of your cirrhosis, different healthcare providers may be involved in your care. What is Alcohol Jaundice Symptoms And Diagnosis. Cirrhosis causes the liver to slow or stop production of proteins needed for blood clotting. When symptoms do occur, they may first include fatigue; weakness and weight loss; nausea; bruising or bleeding easily; swelling in your legs, feet or ankles; itchy skin; redness on the palms of your hands; and spider-like blood vessels on your skin. Cirrhosis itself is not an inherited (passed from parent to child) disease. Tonon M, et al. Median survival in patients with decompensated cirrhosis is approximately two years. But your liver is a large organ. These can help identify how extensive your cirrhosis is by checking for liver malfunction, liver damage, or screening for causes of cirrhosis such as hepatitis viruses. The only way to avoid death is to have a liver transplant. Early symptoms and signs of cirrhosis include: As liver function gets worse, other more commonly recognized symptoms of cirrhosis appear including: Yes, cirrhosis can be painful, especially as the disease worsens. The liver is the second largest organ in the human body and one of the most important for human health. Any illness or condition that affects your liver in the long-term can cause fibrosis. In the process, scar tissue forms. Alagille syndrome, a genetic digestive disorder. Options include surgery to remove part of your liver or your whole liver (to be replaced with a new liver as part of a liver transplantation) and nonsurgical tumor-destroying methods including ablation, chemotherapy, targeted therapy (drugs zero in on cancer genes or tissue), immunotherapy and radiation bead therapy (inject bead that give off radiation into the blood vessels that feed the tumor). Treating the cause of the cirrhosis is also crucial. Blood may also pool up in your portal veins (veins in your liver) and cause them to burst. To provide you with the most relevant and helpful information, and understand which Fiber Consider a high-fiber diet, which can help to improve liver function. If you already have hepatitis, ask your provider if drug treatment is appropriate for you. Rifaximin For Hepatic Encephalopathy Treatment, Everything You Need to Know About Spider Angioma Cirrhosis, Maintaining Liver Health: How to Lower Liver Enzymes, What to Do If You Have Hepatic Encephalopathy, Signs You May Have an Amino AcidDeficiency, How to Live to 100: What You Can Do to Increase Longevity.