Fatty liver may soon be the next endemic: Doctors

ByChetana Belagere

Published Jul 13, 2022 | 5:34 PM Updated Jul 25, 2022 | 4:03 PM

Progression of fatty liver to liver cirrohsis

Liver experts from South India have said they are becoming increasingly concerned over the increasing incidences of fatty liver — including non-alcoholic fatty liver diseases (NAFLDs).

They worry it could become the next big endemic in the country.

Fatty liver has traditionally been associated with excess alcohol consumption. However, it is also extremely common in individuals who do not consume alcohol or drink in moderation.

This condition, known as NAFLD, is on the rise across the country, said the doctors.

“Fatty liver disease is the next big epidemic evolving in our country.  It is estimated that over the next 50 years more than half to two-thirds of all liver problems will have a fatty liver as the background cause,” said Dr Rajiv Lochan J, lead consultant for HPB and liver transplant Surgery at Manipal Hospital.

The Karnataka government’s Health Department, in its list of non-communicable diseases, is already monitoring the liver health of the rural population.

Karnataka’s Health and Family Welfare Commissioner Randeep D told South First, “India is the first country to have added NAFLD to it’s national disease control programs. In Karnataka, due to the increase in these cases, we have added liver-monitoring tests to our Non Communicable Diseases programs even in rural areas.”

What is fatty liver?

“This just means you more than the natural percentage of fat in your liver,” Dr Kaiser Raja, DM Consultant in Liver Diseases at the Dubai branch of the King’s College Hospital London, told South First.

Raja, who also consults patients in Karnataka, explained that if there is no inflammation associated with fatty liver, it can be ignored.

It normally doesn’t cause any damage to liver cells or lead to liver-related problems.

But doctors said there is another condition in which there is inflammation of the liver.

That’s known as Nonalcoholic Steatohepatitis (NASH). This can lead to serious liver scarring, like fibrosis and cirrhosis. It can also lead to cancer.

Who is more at risk?

Raja explained that the rising prevalence of fatty liver is in general related to the adoption of a sedentary lifestyle, consumption of a high-calorie diet, and weight gain.

“So, it exists in those who are overweight and in those with diabetics. Even people with mild obesity who have fat around their abdomen can get this. Women with PCOS are also at risk,” he said.

Dr. Sonal Asthana, lead consultant for hepatobiliary and transplant surgery at Aster CMI Hospital, told South First, “In the Indian population, the prevalence is estimated to be around 9-32%.”

And, like the doctors have already said, this is not an urban problem anymore.

“With many becoming diabetic and adopting a sedentary lifestyle in rural areas, we are seeing an increase in this [number of fatty liver cases]. Some cases have already reached liver damage and cardiovascular diseases,” explained Dr PV Rao, a noted endocrinologist from the Nizam’s Institute of Medical Sciences in Hyderabad.

Dr Manjunath CN, director of Jayadeva Institute of Cardiovascular Diseases, concurred.

“Fatty liver has been seen in many cardiac-arrest and heart-attack cases. It has also led to heart failures in some instances,” he said.

This condition is now being seen in children too.

With obesity increasing in that population, the fatty liver that was limited to adults is now being seen in children as young as 13-18 years, said the doctors.


While most patients get their fatty-liver diagnosis during the ultrasound scan of the abdomen for other reasons, doctors explained that in its early stages it doesn’t even have significant symptoms.

However, doctors have identified some complex symptoms like lethargy and fatigue when waking up in the morning, mild pain and swelling in the right upper part of the abdomen, passing of dark-coloured urine, skin turning yellow or itchy, and even weight loss as indications of a fatty liver.

A simple non-invasive scan known as liver elastography or Fibroscan, which takes less than five minutes, can detect the condition of the liver.

What should patients do?

Once diagnosed with fatty liver, patients need to ensure that they don’t develop diabetes, blood pressure, or high cholesterol.

“A healthy lifestyle, good diet, and normal body usually doesn’t let the condition progress, and such patients won’t even need regular liver-function tests,” explained Kaiser.

“However, they should be wary of progressing to NASH if there is an onset of diabetes or obesity,” he added.