Overview#
Non-Alcoholic Fatty Liver Disease (NAFLD), recently renamed Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), is a condition where excess fat accumulates in the liver without significant alcohol use. It affects an estimated 30-40 % of the Indian urban population, making it the most common liver disorder in India. The condition ranges from simple fatty liver (steatosis) to non-alcoholic steatohepatitis (NASH), which can progress to fibrosis, cirrhosis, and liver cancer. Indians are particularly susceptible due to high rates of insulin resistance, central obesity, and a carbohydrate-heavy diet.
Causes & Risk Factors#
- Insulin resistance and metabolic syndrome – the primary driver; closely linked to Type 2 diabetes.
- Obesity, especially central adiposity – even "lean NAFLD" is common in Indians with normal BMI but high abdominal fat.
- High-carbohydrate, high-fructose diet – excessive rice, maida, sugar, and sweetened beverages drive hepatic fat accumulation.
- Sedentary lifestyle – lack of exercise reduces fat oxidation in the liver.
- Genetic factors – PNPLA3 gene variants are more common in South Asians, increasing susceptibility.
Signs & Symptoms#
- Usually asymptomatic in early stages – often discovered incidentally on ultrasound
- Vague right upper abdominal discomfort or heaviness
- Fatigue and low energy levels
- Unexplained weight gain, especially around the abdomen
- Elevated liver enzymes on routine blood tests
- In advanced stages: jaundice, abdominal swelling (ascites), easy bruising
- Dark patches on the skin (acanthosis nigricans) indicating insulin resistance
Diagnosis#
- Liver Function Test (LFT) – ALT and AST may be mildly elevated (ALT > AST pattern in NAFLD). Book Liver Function Test
- Abdominal Ultrasound – the most common initial test; shows increased liver echogenicity graded as Grade 1 (mild), Grade 2 (moderate), or Grade 3 (severe).
- FibroScan (Transient Elastography) – measures liver stiffness to assess fibrosis non-invasively.
- FIB-4 Index – a simple score using age, AST, ALT, and platelet count to estimate fibrosis risk.
- Lipid Profile, Fasting Glucose, HbA1c – to assess metabolic comorbidities. Book Lipid Profile, Book HbA1c
Treatment Options#
No FDA-approved drug exists specifically for NAFLD. Lifestyle modification is the primary treatment:
- Weight loss – losing 7-10 % of body weight can resolve NASH and improve fibrosis. Even 3-5 % weight loss reduces liver fat.
- Diet: Replace white rice with millets and whole grains, reduce sugar and maida, increase vegetables and protein, avoid sugary drinks and fruit juices, limit fructose (including excess fruit).
- Exercise: 150-200 minutes/week of moderate-intensity exercise (brisk walking, cycling, swimming). Both aerobic and resistance training reduce liver fat independently of weight loss.
- Medications for comorbidities: Metformin for diabetes, statins for dyslipidemia (safe in NAFLD), vitamin E (800 IU/day) for non-diabetic NASH under medical guidance.
- Avoid alcohol completely – even small amounts worsen fatty liver.
Prevention#
- Maintain a healthy waist circumference (< 90 cm men, < 80 cm women for Indians).
- Limit added sugars to < 25 g/day – avoid sweetened beverages, packaged juices, and excess jaggery.
- Choose whole grains over refined carbohydrates at every meal.
- Exercise regularly – even 30 minutes of daily walking provides benefit.
- Get annual liver function tests if you have metabolic risk factors.
When to See a Doctor#
Consult a gastroenterologist/hepatologist if your ultrasound shows fatty liver Grade 2 or above, if liver enzymes are persistently elevated, or if you have diabetes or obesity with fatty liver. Seek urgent care if you develop jaundice, abdominal swelling, or vomiting blood – these suggest advanced liver disease.