Experts warn of rising non-alcoholic fatty liver disease among Indians

New Delhi: Non-Alcoholic Fatty Liver Disease (NAFLD) is emerging as a significant public health concern in India, with prevalence rates among the general population ranging from 9% to 53%.

Experts at Amrita Hospital, Faridabad, highlight that Indians are genetically predisposed to insulin resistance, a key factor in both diabetes and the development of fatty liver.

NAFLD, a condition where fat constitutes more than 5% of the liver’s weight, is becoming one of the leading causes of chronic liver disease, cirrhosis, and liver cancer in India. It is also a common reason for liver transplants. Obesity, diabetes, hypertension, and dyslipidemia, known as metabolic syndrome, predispose individuals to NAFLD. This condition, now termed Metabolic-associated Fatty Liver Disease (MAFLD), is a key component of metabolic syndrome.

Dr. Bhaskar Nandi, Head of Gastroenterology at Amrita Hospital, explains, “NAFLD is asymptomatic till it manifests as cirrhosis in late stages. It is usually diagnosed incidentally on ultrasonography or during evaluation for abnormal liver function tests (LFT). Some patients may experience subtle right upper abdominal discomfort. As the disease progresses to cirrhosis, general ill-health, failing health, low appetite, and features of liver decompensation or portal hypertension emerge like ascites (water in the abdomen), jaundice, blood in vomitus, altered sensorium, renal dysfunction, and sepsis. The advanced form of NAFLD may lead to liver cancer. It is important to note that metabolic disorders like diabetes, hypertension, dyslipidaemia, and obesity aggravate NAFLD and drive it to cirrhosis. In turn, NAFLD is an adverse marker of outcome in metabolic disease.”

To combat this silent killer, prompt medical consultation and further evaluation are necessary for those with fatty liver detected on USG or abnormal LFT results. Screening for obesity and metabolic disorders is crucial, and common liver diseases like hepatitis B and C, as well as drug-induced liver diseases, need to be ruled out. Assessing liver damage through a Fibroscan and, rarely, a liver biopsy can help determine the disease’s progression.

“Lifestyle modification is crucial for treating NAFLD, with strict alcohol abstinence being essential. Patients should aim to reduce their weight by at least 10%, ideally over a year, through diet and exercise. A hypocaloric Indian diet, which involves smaller portions of home-cooked meals, is recommended. Reducing sugar, deep-fried foods, refined foods, and excessive butter and oil is vital. Instead, focus on fruits, vegetables, and legumes, while minimizing cereals and grains. Regular physical activity, with 4-5 weekly sessions of 40-45 minutes each, combining cardio and resistance training, is strongly advised. Detox diets and protein supplements are not recommended,” said Dr. Nandi.

“The liver is not the only organ that fails in fatty liver disease. Patients with NAFLD are at a higher risk of heart attacks, brain strokes, kidney disease, and certain cancers outside the liver. Hence, good control of metabolic diseases like diabetes, hypertension, and dyslipidaemia is essential and so is screening for heart disease,” he added.

Amrita Hospital has taken a proactive approach to tackling this public health issue through its Liver Clinic. The clinic offers comprehensive evaluation and treatment for NAFLD, staffed by a dedicated team of hepatologists, liver surgeons, dietitians, and counsellors. This initiative is part of a broader effort to integrate NAFLD into India’s National Program on Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke by the Ministry of Health and Family Welfare, marking a significant step forward in combating this silent epidemic.