Fatty Liver Crisis: Nearly 4 In 1 Indians Affected, Lancet Study Sounds Alarm

A growing body of research suggests that India is facing a silent epidemic of liver disease, driven not by alcohol but by obesity, diabetes and metabolic dysfunction, conditions that are rising sharply across the population. Recent findings from the Phenome India-CSIR Health Cohort, published in The Lancet Regional Health Southeast Asia, reveal that about 38.9% of Indian adults may have fatty liver disease, and a significant subset already show signs of liver stiffening, or fibrosis, a key early step towards more severe liver damage.

Fatty liver is now often categorised medically as metabolic dysfunction-associated steatotic liver disease (MASLD), a condition closely linked to obesity, insulin resistance, high blood sugar, and other metabolic risk factors. While traditionally fatty liver was associated with excessive alcohol intake, the new Indian data highlights that non-alcoholic forms are far more common, largely driven by lifestyle, diet and metabolic health.

What makes this alarming is that fatty liver is frequently asymptomatic in early stages, meaning many people may be unaware they have it until complications develop. With liver fibrosis, a scarring process that can ultimately lead to cirrhosis or liver cancer, already evident in some individuals, experts stress the need for increased awareness, screening and preventive measures.

What the Studies Show: MASLD and Its Prevalence

The Phenome India cohort, involving more than 7,700 adults from 27 cities across India, found that roughly 38.9% had evidence of fatty liver, a rate comparable to global estimates of non-alcoholic fatty liver disease reported in earlier research.

The study deliberately excluded individuals who consumed alcohol, underlining that the liver changes observed were not linked to drinking. Rather, the condition was strongly associated with obesity and high blood sugar levels (reflected in elevated HbA1c values), highlighting MASLD as a metabolic problem rather than an alcoholic liver disease.

Additionally, liver fibrosis prevalence was higher among those with fatty liver (6.3%) compared to the overall study population (1.7%), indicating that a significant number may already be progressing toward more serious liver disease. Among people with obesity and diabetes, the fibrosis prevalence was even higher, around 8-9%.

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Why This Matters: Metabolic Roots and Risks

MASLD (formerly known as NAFLD, non-alcoholic fatty liver disease) reflects fat accumulation in liver cells due to metabolic dysfunction, often tied to insulin resistance and obesity. Indians appear to be particularly prone to this pattern, partly due to genetic predispositions toward insulin resistance and visceral fat accumulation.

This metabolic dysfunction not only affects the liver but is also intertwined with other chronic diseases such as type-2 diabetes, hypertension, heart disease and chronic kidney disease, creating a web of interrelated risks.

Fatty liver disease is known as a "silent condition" because early stages rarely cause noticeable symptoms. Even routine blood tests can remain normal despite significant fat accumulation in the liver. This makes screening tools such as ultrasound or elastography (FibroScan) crucial for early detection.

The Path From Fatty Liver to Fibrosis and Beyond

• When liver cells become overloaded with fat, this can trigger inflammation and damage over time. Persistent inflammation may lead to fibrosis, a stiffening and scarring of liver tissue that impairs liver function. Left unchecked, fibrosis can progress to cirrhosis, liver failure, and even liver cancer.
• A separate analysis also indicates that liver fibrosis dramatically increases the risk of complications, including liver cancer, and may raise overall mortality risk.
• These dangers are compounded because MASLD often coexists with obesity and glucose intolerance, two conditions that are themselves major public health concerns in India. 

Lifestyle, Diet and Preventive Health: What You Can Do

Unlike many advanced liver diseases, MASLD is highly modifiable through lifestyle changes, especially in early stages. Public health experts and clinicians recommend:

• Maintaining a healthy weight: Weight reduction has been shown to reduce liver fat and improve metabolic health.
• Healthy diet: A diet rich in fruits, vegetables, whole grains and lean proteins, and low in refined sugars and processed foods, can reduce fat accumulation in the liver.
• Regular exercise: Physical activity improves insulin sensitivity and helps reduce liver fat.
• Screening for metabolic risk factors: Regular checks of blood sugar, lipids and liver health (e.g., ultrasound or FibroScan) can catch disease early.
• Experts highlight that sustainable lifestyle modifications have the power to prevent MASLD from advancing toward fibrosis and more serious outcomes. Early intervention is the best strategy, particularly in people with obesity, diabetes or metabolic syndrome.

Also Read: Can Quitting Sugar Benefit Liver Health? Doctor Answers

Why Early Detection Is Critical

MASLD's asymptomatic nature makes early screening and risk assessment essential. Given that many people remain unaware of their condition until significant liver damage has occurred, incorporating liver health checks into routine health screenings, especially for those with obesity or diabetes, can dramatically change outcomes.

A proactive approach involving healthcare providers and individuals is crucial. Healthcare systems need to prioritise education, screening and preventive care programs to stem the rising tide of metabolic liver disease.

The growing prevalence of fatty liver disease in India, now affecting nearly 40% of adults, represents a silent but significant public health threat. Driven by obesity, diabetes and metabolic dysfunction rather than alcohol, MASLD can progress quietly toward fibrosis, cirrhosis and liver cancer if undetected and unmanaged. With evidence mounting from studies like the Phenome India cohort, the case for regular screening, lifestyle interventions and public awareness has never been stronger.

Individuals with metabolic risk factors should prioritise lifestyle changes and discuss liver health screening with their clinicians. Early action offers the best chance of reversing fatty liver, preventing fibrosis and protecting long-term health.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.