Written by: Dr Harsh Kapoor
5 min readNew DelhiJul 31, 2023 06:15 PM IST
First published on: Jul 31, 2023 at 04:15 PM IST
The recent AIIMS study, which says that over one-third (38 per cent) of Indians have fatty liver or non-alcoholic fatty liver disease (NAFLD), is concerning to say the least. But what’s most worrisome is that the phenomenon is not restricted to adults but affects nearly 35 per cent of the children as well, says the study published in the Journal of Clinical and Experimental Hepatology in June 2022.
Non-alcoholic fatty liver disease (NAFLD) is often unrecognised since it does not cause symptoms in the early stage, but may progress in some patients with severe liver disease. So early diagnosis is required at all costs. NAFLD happens because of four reasons — uncontrolled diabetes, dyslipidemia or excess bad cholesterol, obesity (when you are overweight by over 10 per cent of your body mass index or BMI) and a sedentary lifestyle. Usually, the lifestyle benchmarks include lack of exercise, poor diet, overconsumption of fried or processed foods, sweets and red meat.
So, what are the causes of NAFLD in young people? India has witnessed significant urbanisation and economic growth in recent years, leading to lifestyle changes among the younger generation. Urbanisation often brings about sedentary lifestyles, increased consumption of processed and high-calorie foods, and reduced physical activity. These lifestyle changes contribute to weight gain, obesity, and metabolic disturbances, all of which are major risk factors for NAFLD.
Westernised diet: The adoption of a Westernised diet, high in refined carbohydrates, saturated fats and sugary beverages, is becoming increasingly common among the young population in India. This dietary shift contributes to metabolic dysregulation and fat accumulation in the liver, increasing the risk of NAFLD. Fat destroys hepatocytes and scars liver tissue. But this is a slow process and without realising, the liver gets damaged and by the time the child is an adult, he would have developed serious complications to such an extent that the damage could be irreversible. An adult who is diagnosed with NAFLD in his 20s or 30s has a much higher chance of recovery and survival than somebody who had been unaware of NAFLD in their growing up years and show symptoms in adulthood.
A fatty liver can be reversed if it is caught in the earlier stages, when there is only fat, but no inflammation or fibrosis.There is an urgent need for parents to plan meals for their children in advance and factor in their preparation than just cram in shop shelf variety convenience foods, processed and ultra processed ones being the worst culprits, especially when had with carbohydrate-heavy tiffin. Besides, our regular diet is laden with sweet and oily foods.
Obesity Epidemic: Obesity has become a significant public health concern in India, affecting people of all age groups, including the young. Excess body weight and obesity are closely linked to NAFLD, as they trigger insulin resistance and lead to fat accumulation in the liver. Poor dietary choices and lack of regular exercise are primary drivers of the obesity epidemic. In fact, we are setting up a paediatric liver disease clinic, where children with a high body mass index (BMI) are immediately advised a fibroscan to measure liver scarring or fibrosis.
Insulin Resistance and Diabetes: The prevalence of Type 2 diabetes is rising in India, and insulin resistance is often a precursor to diabetes. Insulin resistance impairs the body’s ability to control blood sugar levels, leading to an increased risk of fatty liver. As more young people develop insulin resistance and diabetes, the incidence of NAFLD also increases.
Genetic Predisposition: Genetic factors also play a role in the development of NAFLD. Some children may have a genetic predisposition to NAFLD, making them more susceptible to the disease even without significant metabolic risk factors.
Lack of Awareness and Routine Screening: NAFLD is often asymptomatic in its early stages, leading to underdiagnosis or delayed diagnosis. Young individuals may not be aware of their liver health or consider it a concern until the disease progresses to more advanced stages. Routine liver function tests and awareness about NAFLD are essential for early detection and timely intervention.
Socio-economic factors: Socio-economic factors, such as access to healthcare facilities, education and awareness about healthy lifestyle choices can influence the prevalence of NAFLD. Disparities in healthcare and health education may contribute to higher rates of NAFLD among certain populations.Addressing the rising prevalence of NAFLD among the young in India, therefore, requires a multi-faceted approach. Public health initiatives should focus on promoting healthy lifestyle habits, improving access to nutritious food options, and encouraging regular physical activity. Additionally, raising awareness about NAFLD, routine screening, and early intervention are essential to curb the burden of this liver disease and promote better liver health among the young population in India.
The AIIMS study’s findings serve as a wake-up call for healthcare authorities and policymakers to make concerted efforts in combating NAFLD and its risk factors for a healthier and a vibrant future for the young generation.
Non-alcoholic fatty liver disease (NAFLD) is often unrecognised since it does not cause symptoms in the early stage but may progress in some patients with severe liver disease. (Source: Freepik) 
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