Bengaluru: A nationwide study published in The Lancet Regional Health Southeast Asia found nearly 40% of Indian adults — about 4 in 10 people — have metabolic dysfunction-associated steatotic liver disease (MASLD), commonly known as non-alcoholic fatty liver disease.
The study also noted a concerning trend: Four per cent of the individuals, particularly older adults with diabetes, hypertension, abnormal cholesterol, or obesity, already show liver fibrosis, increasing the risk of cirrhosis.
The research analysed 7,764 adults across 37 Council of Scientific and Industrial Research (CSIR) laboratories in 27 Indian cities. Obesity emerged as the strongest driver, with many participants also having three or more cardiovascular risk factors. In metropolitan areas such as Bengaluru, age-adjusted MASLD prevalence ranged between 37% and 42%, according to the study.
However, when TOI checked with hepatologists in the city, they said outpatient figures of MASLD in most hospitals could be higher — around 50–60%. Dr Naveen Ganjoo, senior consultant – hepatology & integrated liver care, Aster RV Hospital, said: "We conducted our own study among 700 IT professionals in the city, and nearly 71% of them were found to have fatty liver. The primary causes appeared to be poor lifestyle habits like irregular eating patterns, night shifts, lack of physical activity, and poor circadian rhythm. While the condition is more common among people with diabetes and those who are overweight, in India, even lean individuals with familial diabetes are increasingly at risk—a condition sometimes referred to as ‘lean metabolic dysfunction'."
Dr Sunil S Bohra, consultant internal medicine, Apollo Hospitals, Seshadripuram, said most cases are detected during routine or pre-employment health check-ups. "If the ultrasound indicates fatty changes, we do liver screening and, if required, assess fibrosis. Fibrosis is more common after 45 years and may worsen with alcohol intake," he said.
Doctors are also seeing MASLD increasingly in younger adults aged 20–45. Dr Ravindra Nidoni, consultant – liver transplant & HPB Surgeon, Gleneagles BGS Hospital, described a recent case of a 21-year-old weighing about 100kg who was diagnosed during a pilot fitness evaluation despite no alcohol use. "Severe sedentary behaviour, fast food consumption, and sugary drinks were key contributors in his case, showing fatty liver is now driven largely by diet, inactivity, and metabolic risk," he said.
"A major concern is that fatty liver is usually asymptomatic early on. Nearly 90–95% of patients have no symptoms, and about 10% may silently progress to fibrosis and cirrhosis," said Dr Sandeep Satsangi, lead consultant – hepatology and transplant hepatology, Manipal Hospital Old Airport Road.
"Fibrosis is classified from F0 (normal) to F4 (cirrhosis). Stages F1 to F3 can often be reversed with appropriate medication, calorie-deficit diets, improved nutrition (better protein and fibre balance), reduced sedentary behaviour, and regular physical activity. Lifestyle correction significantly improves treatment outcomes," he said.
Inset:
What is MASLD?
It is a condition in which excess fat builds up in the liver due to obesity, diabetes, high blood pressure, or abnormal cholesterol, rather than alcohol use. Measures to prevent, manage or try reverse the condition include:
Avoid sugar and refined carbs, and add more protein and fibre to the diet
Stay physically active and reduce long hours of sitting or screen time
Maintain a healthy weight and control diabetes, blood pressure, and cholesterol
Avoid alcohol if diagnosed with fatty liver
Get regular health check-ups for early detection and prevention of progression
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