A couple of decades ago, fatty liver was almost always assumed to be due to alcohol, and most liver damage was labelled as alcoholic liver disease (ALD). The term NAFLD barely existed. Today, it has become one of the most common metabolic disorders worldwide.
What is NAFLD.
NAFLD refers to accumulation of fat in the liver not caused by alcohol. It ranges from simple fat deposition to NASH (inflammation), fibrosis, cirrhosis and even liver cancer. It is now seen as the liver component of metabolic dysfunction, strongly linked with obesity, insulin resistance and type 2 diabetes (T2DM).
A Brief History.
Early pathologists noticed fatty livers in autopsies, but the modern understanding began in 1980, when Ludwig et al. described NASH in non-drinkers. This landmark discovery reframed fatty liver as a metabolic disease, not an alcohol-related one.
Global Snapshot.
- 25% of adults globally have NAFLD.
- Over 1 billion cases worldwide, rising alongside obesity and diabetes, with Asia contributing heavily.
- In people with T2DM, NAFLD prevalence often exceeds 50%, and the presence of NAFLD both increases diabetes risk and worsens diabetes-related outcomes.
India: Higher and Growing Burden
- Indian studies show a wide prevalence (9–50%+), but most modern analysis place national averages at 30–40%, higher than the global mean.
- In people with T2DM, NAFLD affects 50–60%, with some cohorts reporting up to 70%.
- Urban India shows much higher rates (30–50%+) than rural areas (8–10%), driven by lifestyle, diet and rapid urbanisation.
Why India Shows Higher Numbers?
- Rapid nutrition and lifestyle transition.
- High insulin resistance at lower BMI (Asian phenotype).
- Underdiagnosis and hospital-based sampling that reveals higher hidden burden.
Why It Matters?
- Heart disease and not liver failure is the leading cause of death in NAFLD.
- The burden of disability, cirrhosis and liver cancer (HCC) is rising across Asia, including India.
- With India’s massive T2DM population, NAFLD progression will accelerate if not addressed early.
Clinical Connections (Important for India).
- NAFLD increases risk of developing diabetes, and diabetes accelerates NAFLD progression.
- NAFLD also independently raises cardiovascular event risk, making combined metabolic management essential.
India’s Priority Actions.
- Screen high-risk individuals, especially those with T2DM, metabolic syndrome or elevated liver enzymes.
- Expand access to FibroScan/CAP and fibrosis scoring tools like FIB-4.
- Treat metabolic drivers: weight loss, diet, exercise, glucose and lipid control.
- Population-level steps to reduce obesity and sedentariness.
- Invest in robust Indian registries and cohort studies.
Bottom Line.
NAFLD affects 1 in 4 adults globally, and the burden in India is even higher. With rising obesity and diabetes, NAFLD is set to become one of India’s major metabolic challenges. Early detection and lifestyle-based reversal remain our biggest opportunities.
The Good News
NAFLD/MASLD is reversible, and a scientifically designed Low-Carb High-Fat (LCHF) diet, combined with exercise, can significantly reduce liver fat and improve metabolic markers.
We’re here to guide you through personalised diet and lifestyle strategies to reverse fatty liver.
Connect with us and say goodbye to NAFLD without any medication.
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