Published Feb 09, 2026 | 6:39 PM ⚊ Updated Feb 09, 2026 | 6:39 PM
Representational image. Credit: iStock
Synopsis: A nationwide CSIR-led study published in The Lancet Regional Health – Southeast Asia found metabolic dysfunction-associated steatotic liver disease (MASLD) affects two in five adults in Bengaluru, Chennai, and Hyderabad, slightly above India’s 38.9% average. Obesity and diabetes emerged as key drivers, with lean MASLD also observed. Researchers urge population-level screening and policy action to address this silent public health burden.
Bengaluru, Chennai, and Hyderabad recorded nearly identical prevalence rates of metabolic dysfunction-associated steatotic liver disease, with two in five adults in these southern metros carrying liver fat, a nationwide study found.
The three cities showed prevalence rates clustered between 40.6 percent and 41.2 percent, placing them slightly above the national average of 38.9 percent, according to research published in The Lancet Regional Health – Southeast Asia.
Bengaluru recorded 40.6 percent prevalence, Chennai 41.2 percent, and Hyderabad 40.9 percent. The findings emerged from the Phenome India cohort, which screened over 10,000 adults across 27 Indian cities between December 2023 and June 2024.
“MASLD affected over one-third of participants,” the researchers noted in the study.
Southern cities, however, showed variation within the region. Thiruvananthapuram recorded the lowest prevalence in the entire country at 27 percent, while Mysore showed 39.9 percent and Karaikudi 35.7 percent.
The study identified 7,764 participants for final analysis after screening 10,267 individuals. Of these, 3,712 people met criteria for MASLD, formerly known as fatty liver disease.
“MASLD affected over one-third of participants. Site-specific disparities were observed, which suggest the need for large-scale longitudinal studies to elucidate region-specific risk factors and temporal trends,” the researchers wrote.
Women in southern India recorded comparatively higher rates than women elsewhere in the country, the study found. Post-menopausal women showed increased risk, suggesting hormonal and metabolic factors influenced the pattern.
In Mysore, men showed 56.2 percent prevalence while women recorded 30.5 percent. Chennai men showed 48.4 percent compared to women at 33.7 percent. Bengaluru recorded 51.1 percent in men and 34.4 percent in women.
Cities in central and northern regions recorded higher overall prevalence. Roorkee and Bhopal approached 50 percent, marking the highest rates in the study. Bhopal showed 51.8 percent prevalence, while Roorkee recorded 48.3 percent.
Delhi showed 41.3 percent, Lucknow 43.2 percent, and Chandigarh 38 percent. Jammu recorded 45.7 percent, Dhanbad 46.5 percent, and Srinagar 54.4 percent.
Eastern cities fell in the middle range. Kolkata showed 34.1 percent, Bhubaneswar 36 percent, and Durgapur 34.5 percent. Jamshedpur recorded 34.9 percent.
Western cities varied. Pune showed 37.9 percent, while Goa recorded 34.6 percent. Bhavnagar showed 45.5 percent.
The north-east showed lower prevalence. Jorhat recorded 32.7 percent, below the national average.
The study, conducted by researchers from the Council of Scientific and Industrial Research, recruited permanent staff members, retirees, and their spouses from 37 CSIR laboratories across the country. All participants provided voluntary consent.
Researchers used transient elastography, a technique that measures liver stiffness and fat content without invasive procedures. The method allowed large-scale community screening without requiring liver biopsies.
Obesity drives disease, but lean individuals also affected
Obesity emerged as the strongest driver of disease. Individuals with class II obesity faced nearly fourteen times higher odds of MASLD compared to those with normal weight. Diabetes more than doubled the risk, while high blood pressure and abnormal cholesterol levels further increased vulnerability.
“Obesity was observed to be the predominant driver of MASLD in India, with additional contributions from diabetes, dyslipidemia, elevated blood pressure, and central adiposity,” the study stated.
The research identified a subset of lean MASLD, where individuals with normal body weight still developed fatty liver disease. These cases appeared in association with diabetes and central obesity, challenging assumptions that fatty liver affects only visibly overweight individuals.
“Our data also confirm the presence of lean MASLD, particularly associated with Type 2 diabetes, likely reflecting greater visceral rather than subcutaneous adiposity,” the researchers wrote.
The study also flagged liver fibrosis, a more advanced stage of liver damage where scar tissue replaces healthy liver cells. Significant fibrosis appeared in 2.4 percent of the overall population and in 6.3 percent of individuals with MASLD.
Fibrosis clustered among older adults, people with diabetes, and those with severe obesity. Among people with diabetes, 9.1 percent showed fibrosis. Among individuals with class II obesity, 8.1 percent showed fibrosis.
Regional variation in fibrosis appeared across the country. Jorhat recorded 8.3 percent fibrosis prevalence, Delhi 4.8 percent, Jammu 4.3 percent, and Bhopal 4.4 percent. Southern and eastern regions showed lower fibrosis prevalence.
The age-adjusted prevalence in females stood at 33 percent and in males at 45.9 percent across the country. Men showed higher overall prevalence than women, though the pattern reversed in some southern cities.
Among the 3,712 MASLD participants, 66.4 percent of individuals with diabetes carried the condition. The study found 1,280 of 1,927 people with diabetes had MASLD.
“In our study, 66.4 percent of participants with diabetes had MASLD, while 9.1 percent had fibrosis,” the researchers noted.
The condition progresses silently. Most individuals showed no symptoms until reaching advanced stages, when liver function begins to decline.
MASLD develops when fat accumulates in liver cells alongside metabolic problems like obesity, diabetes, high blood pressure, or abnormal cholesterol levels. Simple fat accumulation can progress to inflammation, then to fibrosis as scar tissue forms, and eventually to cirrhosis or liver failure in severe cases.
The study examined 48 cytokines and found 40 showed higher levels in the MASLD group compared to those without the condition. Molecules associated with inflammation, including IL-7, IL-8 and CXCL10, appeared approximately two-fold higher in individuals with fibrosis.
“The transition to fibrosis may be accompanied by an intensified inflammatory milieu,” the study stated.
Researchers collected clinical, biochemical, and anthropometric data alongside liver measurements. Participants underwent blood tests measuring glucose, cholesterol, triglycerides, and other metabolic markers. Staff measured weight, height, waist circumference, and hip circumference using standardized equipment.
The study used a controlled attenuation parameter score of 248 decibels per meter or higher to define steatosis, the medical term for fat accumulation in the liver. Researchers also tested alternative thresholds to confirm findings remained consistent.
“We examined prevalence estimates using multiple established CAP cut-offs and the demographic and clinical characteristics of individuals identified as having steatosis remained consistent,” the researchers wrote.
The Phenome India cohort comprises predominantly urban, educated individuals, largely drawn from CSIR employees and their families. Most participants belonged to urban and semi-urban middle and higher-middle income groups.
The researchers acknowledged this limitation. “The Phenome cohort may not be able to fully capture the socio-economic, educational, and rural diversity of the broader Indian population,” they wrote.
The study excluded individuals reporting any alcohol consumption to ensure accurate MASLD classification by removing potential confounding from alcohol-related liver injury.
Previous research showed pooled NAFLD prevalence in India at 38.6 percent, with community-based data showing 28.2 percent. Urban studies in Delhi and Chennai reported higher estimates at 56.4 percent and 61.5 percent respectively.
“A previous systematic review for NAFLD from India showed a pooled prevalence of 38.6 percent in adults with community-based data showing 28.2 percent,” the study noted.
Global MASLD prevalence stands at 38 percent, with Latin America showing the highest rates at 44 percent, followed by the Middle East and North Africa at 36.5 percent, and South Asia at 33.8 percent.
The researchers called for policy changes to address the growing burden.
“The high prevalence of MASLD and liver fibrosis in India represents an urgent public health challenge. Our findings advocate for policy shifts to include transient elastography-based screening, especially for urban and high-risk populations,” the authors said.
They recommended training healthcare workers to use transient elastography and integrating liver screening with existing metabolic disease programs.
“Training healthcare workers to use transient elastography and integrating it with existing metabolic disease programs could enhance scalability,” the study stated.
The authors warned that without intervention, the rising burden of MASLD and fibrosis could strain India’s healthcare system, increasing risks of cirrhosis, liver cancer, and cardiovascular disease.
“These figures highlight the subclinical nature of early MASLD and its silent progression, which poses a potential burden to the public health systems if left unaddressed,” the researchers wrote.
They urged policymakers to consider population-level screening strategies, particularly for urban groups at high risk, alongside lifestyle and metabolic risk reduction measures.
“Community-based awareness and targeted public health interventions across diverse geographical and socio-cultural settings in India may help curb the rising burden,” the authors concluded.
The study called for longitudinal research to track trends in MASLD and liver fibrosis over time and evaluate the impact of screening interventions.
“Future longitudinal studies are needed to track trends in MASLD and liver fibrosis and evaluate the impact of screening interventions,” the authors said.
(Edited by Amit Vasudev)
