NEW DELHI: India is facing a silent but rapidly escalating health crisis as fatty liver disease places the country among the world’s top three most affected nations. Once considered a relatively benign condition, fatty liver disease has now emerged as one of the most common and serious chronic liver disorders globally, driven largely by rising obesity, diabetes, and sedentary lifestyles.
A recent global study published in the Journal of the American Medical Association highlights that metabolic dysfunction-associated steatotic liver disease (MASLD), earlier known as non-alcoholic fatty liver disease, affects nearly 30-40 per cent of the adult population worldwide. Alarmingly, the burden is disproportionately high among people with metabolic disorders. Nearly 60-70 per cent of individuals with type 2 diabetes and up to 80 per cent of those with obesity are found to have fatty liver disease.
India’s situation is particularly concerning. Between 2010 and 2021, the country recorded a 13.2 per cent rise in age-standardised prevalence, ranking just behind China and Sudan. Experts warn that MASLD is far more than a lifestyle-related inconvenience—it is strongly associated with liver cancer, cardiovascular disease, stroke, and premature death.
To understand why India is witnessing such a sharp rise, Dr Ayush Verma, Department of Hepatology at Lady Hardinge Hospital.
NOT A NEW DISEASE, BUT A GROWING THREAT
According to Dr Verma, fatty liver disease is not a new phenomenon in India, but its true scale has become evident only in recent years. “Fatty liver was always present. What has changed is the sharp increase in metabolic risk factors like obesity, type 2 diabetes, and sedentary lifestyles. As a result, the actual prevalence has genuinely gone up,” he said.
He explained that improved awareness and diagnostic tools have also played a major role in identifying more cases. “Earlier, fatty liver was grossly underdiagnosed. Today, people undergoing routine health check-ups, ultrasounds, CT scans or MRIs for other reasons, and fatty liver is often detected incidentally,” he noted.
Medical understanding of the disease has also evolved significantly. “In the 1990s and early 2000s, fatty liver was not taken seriously. It was discussed but not recognised as a major public health threat,” Dr Verma said. What has changed is the growing evidence linking fatty liver to life-threatening complications beyond the liver.
“We now know that fatty liver is strongly associated with cardiovascular mortality, stroke, and cancer—often occurring even before cirrhosis develops,” he warned. This shift has made early detection and prevention a critical priority.
WHY INDIANS ARE ESPECIALLY VULNERABLE
One of the key reasons for India’s high burden lies in biological predisposition. “South Asians are more prone to developing metabolic risk at lower body weight,” Dr Verma explained. Indians tend to accumulate more visceral fat—the harmful fat around internal organs—even when their BMI appears normal.
“This is known as the TOFI phenotype—’Thin Outside, Fat Inside’. A person may look lean but still carry high metabolic risk due to abdominal fat,” he said. This makes Indians more vulnerable to insulin resistance and fatty liver disease.
Lifestyle changes have further worsened the situation. “There has been a sharp rise in ultra-processed foods, sugary beverages, refined carbohydrates and frequent snacking,” Dr Verma said. Combined with reduced physical activity, increased screen time, poor sleep, and high stress, these habits accelerate metabolic dysfunction.
Importantly, MASLD is not just a liver condition. It is closely linked to heart disease, stroke, cancers and increased overall mortality,” he said. The extent of liver fibrosis—scarring of the liver—plays a crucial role in determining long-term outcomes.
“In early stages, patients are more likely to die from cardiovascular disease or cancer. Once cirrhosis develops, liver-related complications become the leading cause of death,” Dr Verma explained.
NO LONGER JUST AN URBAN DISEASE
Fatty liver disease is no longer confined to urban India. “The urban-rural gap is narrowing rapidly,” Dr Verma said, citing growing evidence of high prevalence in rural populations as well.
While urban residents still face slightly higher risk due to sedentary jobs and greater access to fast food, rural lifestyles are also changing. “Processed and packaged foods are increasingly consumed in rural areas, and physical labour has reduced due to mechanisation,” he said.
As a result, obesity, diabetes, and fatty liver are rising across both urban and rural India, making MASLD a nationwide public health concern.
PREVENTION REMAINS THE STRONGEST CURE
Dr Verma stressed that fatty liver disease is largely preventable, especially when detected early. “Weight management is the single most important factor. Maintaining a moderate body weight significantly reduces risk,” he said.
He recommended simple dietary changes, including avoiding ultra-processed foods, sugary drinks, refined carbohydrates and bakery products. “Many fruit juices marketed as healthy are actually loaded with sugar,” he cautioned.
Instead, he advised a balanced, Mediterranean-style diet adapted to Indian food habits, rich in vegetables, lentils, fruits, nuts, curd, lean proteins and limited cooking oil. Regular physical activity is equally essential. “At least 150 minutes of moderate exercise per week, along with strength training, can dramatically reduce metabolic risk,” he said.
Early screening is crucial for people with diabetes, obesity, abnormal cholesterol levels or raised liver enzymes. “Fatty liver is one condition where prevention truly is the cure,” Dr Verma concluded. “If the liver stays healthy, the body stays healthy.”
