Non-Alcoholic Fatty Liver Disease (NAFLD) is affecting millions, often slipping under the radar until its later stages. Linked closely to diabetes, obesity, and other metabolic disorders, NAFLD is more than a liver health issue—it’s a wake-up call.
As a public health professional, I’ve seen first hand how health challenges can intertwine and build over time, often unnoticed, until they become a nationwide concern. NAFLD is one such condition, gradually emerging as a “silent epidemic” across India. Let’s explore its connections to broader health battles, and its impact on Indian men, women, and children.
NAFLD occurs when excess fat builds up in the liver, unrelated to alcohol, driven by lifestyle and metabolic factors. It ranges from simple steatosis (fat accumulation) to non-alcoholic steatohepatitis (NASH), which can advance to cirrhosis or liver cancer. Its early stages are often symptomless, making it a hidden threat. In India, where liver diseases already pose a significant burden, NAFLD’s rise is a pressing public health issue, tied to the surge in non-communicable diseases (NCDs).
Liver Health: A Growing Crisis in India
India is witnessing a shift from infectious diseases to an NCD onslaught, with NAFLD at the forefront. A 2021 review estimated that 38.6% of Indian adults—nearly one in three—are affected. Among children, the prevalence is 35.4%, fuelled by urbanisation, sedentary lifestyles, and high-calorie diets. Once rare in younger groups, NAFLD now exceeds 50% in some high-risk paediatric populations. In Bhopal, a 2023 study found 43.6% of adults with NAFLD, 18.6% showing severe changes, reflecting a reality that spans urban and rural India alike.
The Web of Connections: Diabetes, Obesity, and Beyond
NAFLD rarely stands alone; it’s interwoven with metabolic syndrome, including obesity, type 2 diabetes, hypertension, and dyslipidaemia. With 77 million Indian adults living with diabetes (2019 data) and projections of 134 million by 2045, NAFLD is a frequent companion—studies show 70% of diabetic individuals have it, driven by insulin resistance. Obesity heightens this risk, affecting over 135 million Indians. NAFLD prevalence reaches 63.4% among obese children and over 50% in high-risk adults, such as those eligible for bariatric surgery. NFHS-4 (2015–2016) reported obesity rates of 21% in women and 19% in men, with abdominal obesity, especially in women, a key factor. This cycle—liver fat worsening insulin resistance, elevating blood glucose, and obesity amplifying both—is compounded by hypertension and high triglycerides in 40–83% of cases.
Demographic Insights: Men, Women, and Children
The impact of NAFLD varies across demographics. Among adults, men show higher prevalence—sometimes double that of women—possibly due to visceral fat and lifestyle factors like smoking or stress. Yet, women face significant risks, with NFHS-4 data indicating higher obesity rates (21% vs. 19% in men), particularly in urban areas. A 2020 Southern India study found NAFLD in 73.6% of severely obese women, underscoring gender-specific vulnerabilities. Children are an emerging concern, with over one-third affected—63.4% among obese youth versus 12.4% in non-obese peers—driven by urban lifestyles, processed foods, and reduced activity.
The Silent Nature of NAFLD
NAFLD’s “silent” label stems from its subtle signs—fatigue or mild discomfort often goes unnoticed. Unlike viral hepatitis, it lacks clear early warnings, and screening is limited outside high-risk groups. In India, healthcare disparities worsen this, leaving many undiagnosed. NFHS-5 (2019–2021) data showed nearly half of diabetes and hypertension cases newly detected, hinting at a vast hidden NAFLD burden.
Addressing the Challenge
Tackling NAFLD demands a multifaceted response. Raising awareness is vital—educating communities about nutrition, exercise, and regular check-ups can help in early detection. Targeted screening for high-risk groups (those with obesity, diabetes, or metabolic syndrome) using tools like ultrasound or FibroScan is a practical step.
At the policy level, the integration of NAFLD into the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS), launched by Dr Harsh Vardhan in 2021, marks India as the first nation to prioritise this within its NCD framework. Yet, challenges persist. To maximise impact, we must work harder to strengthen policy implementation, expand healthcare coverage, and extend awareness and services to grassroots and remote areas. The evidence emphasises disparities in NCD detection and access, highlighting the urgent need to bridge these gaps for equitable reach and lasting change.
Individual actions also play a role. Choosing water over sugary beverages, including physical activity into daily routines, and reducing processed food intake can mitigate liver fat accumulation. For children, schools could promote nutritious meals rich in prebiotics and probiotics, alongside active lifestyles, to support gut health and prevent NAFLD’s onset.
The Road Ahead
NAFLD, interwoven with diabetes and obesity, affects 38.6% of adults and 35.4% of children, with distinct impacts on men and women. As a public health advocate, I see this as more than a statistic—it’s a preventable tragedy. Through enhanced awareness, proactive screening, and healthier living, we can turn the tide. India’s liver health—and its future wellbeing—hinge on our response.
Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.
