Ahmedabad: Studies show that Non-Alcoholic Fatty Liver Disease (NAFLD) is prevalent among 9-53% of the general population. While these statistics are largely driven by a combination of environmental and genetic factors, experts highlight that Indians have a heightened predisposition to insulin resistance, a condition that not only underlies diabetes but also significantly contributes to the development of fatty liver. This genetic inclination towards insulin resistance contributes significantly to such prevalence of development of NAFLD among the Indian population.

What is NAFLD

NAFLD is a public health problem in India, as it is in the rest of the world. It is widely prevalent and is a silently progressive disease and has emerged as one of the leading causes of chronic liver disease, cirrhosis, liver cancer and is a common reason for liver transplant in India. NAFLD, defined as one in which lipid (primarily triglyceride) accounts for more than 5% of the weight of the liver. It implies build-up of fat in the liver in individuals who do not have significant consumption of alcohol intake. Obesity, abdominal obesity, diabetes, hypertension, dyslipidaemia or collectively called as metabolic syndrome, are the predisposing factors for NAFLD. It is also an integral component of Metabolic Syndrome and its current accepted terminology is Metabolic-associated fatty live disease (MAFLD).

NAFLD is asymptomatic till it manifests as cirrhosis in late stages

Dr. Bhaskar Nandi, Gastroenterologist at Amrita Hospital said, “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 abdomen), jaundice, blood in vomitus, altered sensorium, renal dysfunction, and sepsis. 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 drives it to cirrhosis. In turn, NAFLD is an adverse marker of outcome in metabolic disease.”

Prompt medical consultation is required to arrest the disease and save the liver from damage. Fatty liver on USG or abnormal LFT in routine health check need further evaluation. A screening is must for obesity and presence of metabolic disorders. Common liver disease like hepatitis B and C as well as drug induced liver diseases are ruled out. A Fibroscan is done to assess liver damage and progressive disease. Biopsy of the liver is rarely required.

Lifestyle Modifications Crucial

“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.

Awareness in this regard is vital, and the integration of 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 marks significant progress in combating this public health issue.