Rajesh Kumar had never given much thought to his liver. At 42, he resembled many urban professionals in Mumbai: long working hours, frequent business meals, minimal exercise, and an expanding waistline he kept promising to tackle “soon”.
The signs were subtle at first: persistent fatigue, occasional bloating—nothing that seemed alarming. During a routine health check-up, his doctor noted mildly elevated liver enzymes.
“Do you drink?” the doctor asked.
“Rarely,” Rajesh replied.
An ultrasound was advised. The report read: fatty liver.
Relieved that it was not alcohol-related, Rajesh dismissed it. “It’s common these days,” he thought. No treatment was initiated and life continued as usual.
What Rajesh did not realise was that fatty liver disease, now increasingly termed metabolic dysfunction-associated steatotic liver disease (MASLD), is not always benign.
In India today, nearly one in three adults may have fatty liver, with prevalence estimates ranging from 30 to nearly 40 per cent in urban populations. Among those with diabetes or obesity, the figures are even higher, often exceeding 50 per cent.
The concern extends far beyond fat accumulation in the liver. For many, the disease progresses silently from simple steatosis to inflammation (NASH), then to fibrosis, cirrhosis, and even liver cancer. Most patients remain asymptomatic throughout this progression.
Two years later, Rajesh returned for another check-up. This time, the reports were more concerning. His liver enzymes had risen further, and a specialised scan suggested early fibrosis.
He was now diagnosed with NASH: non-alcoholic steatohepatitis.
India faces a distinct metabolic challenge. Even individuals who are not visibly obese may harbour excess visceral fat, particularly around the abdomen. Combined with rising rates of type 2 diabetes, diets high in refined carbohydrates, and sedentary lifestyles, this creates an ideal milieu for fatty liver disease.
Fatty liver has emerged as one of the leading causes of cryptogenic cirrhosis and is increasingly contributing to liver cancer in India.
One of the greatest challenges is detection. NAFLD is typically identified incidentally through abnormal liver function tests or ultrasound findings. Further evaluation may include FibroScan or non-invasive scoring systems. Despite this, routine screening remains limited.
When Rajesh received his diagnosis of NASH, he expected medication. Instead, his doctor stressed lifestyle modification.
He was advised to aim for a 7-10 per cent reduction in body weight, adopt dietary changes and engage in regular physical activity. Over the following months, Rajesh made incremental adjustments: home-cooked meals, reduced sugar intake, and daily walks.
Six months later, he had lost weight, his liver enzyme levels had improved, and hepatic fat had reduced.
At present, there is no single definitive cure for NAFLD/NASH, although therapies such as Vitamin E, pioglitazone, and saroglitazar are used selectively. Newer treatments, including GLP-1 receptor agonists, show promise, particularly due to their weight-loss benefits.
Even so, lifestyle modification remains the cornerstone of management.
Fatty liver is not merely a hepatic condition, it is a metabolic disorder. Patients face an elevated risk of cardiovascular disease, progression of diabetes and kidney disease. Rajesh’s story had a favourable outcome, not because of a miracle drug, but due to awareness and timely intervention.
Across India, millions may be living with fatty liver disease without knowing it. The condition is silent, but its consequences are not. Early detection, sustained lifestyle changes and long-term commitment can not only halt progression but, in many cases, reverse the disease and prevent serious complications.
(Dr Anish Desai is a healthcare entrepreneur. He is leading IntelliMed Healthcare Solutions)
