‘I thought it was a digestive problem’: How 27-year-old’s fatty liver went unnoticed

Aman was finally diagnosed with Grade 2-3 fatty liver and had a liver fibrosis score of 6.

A Grade 2-3 fatty liver means there is a fair amount of fat deposited on the liver, more than mild. A fibrosis score of 6 means the liver has been scarred — signalling that the organ is under strain and starting to stiffen from the fat buildup. In some cases, it means permanent, irreversible damage to the liver.

His experience reflected a trend doctors are now increasingly seeing across India: fatty liver can develop without obvious symptoms, and liver enzymes can remain normal even when fat has accumulated in the liver, said Dr M Irtaza, Senior Consultant, Gastroenterology, Indraprastha Apollo Hospitals, Delhi.

A new normal

Aman recalled how the condition began to affect even his everyday life. “I had difficulty eating rotis. I used to eat boiled eggs, but even that would cause me problems.”

Now 32, Aman has been undergoing treatment at the Institute of Liver and Biliary Sciences (ILBS) in Delhi for the past five years and takes medication regularly.

“I take Bilypsa capsules, vitamin E and Glutathione-T tablets twice a day,” he said.

He has also overhauled his diet and routine. “I strictly take 1 gram of protein per kg of my body weight (75 kg).”

He eats green vegetables, takes vitamins C and E, exercises regularly and makes sure he walks every day. He also drinks green tea and has been advised to have three cups of black coffee without sugar a day.

“I am maintaining a low, healthy weight. I have been advised not to bulk up during this period.”

Aman has also cut down on sugary and oily foods, limits spicy food, and keeps butter and cheese to a minimum.

Even at his wedding last December, he stuck to his routine. “I ate only my diet food,” he said.

Why a fatty liver can go unnoticed

According to Apollo Hospitals’ Health of the Nation Report 2026, among 49,032 people with ultrasound-confirmed fatty liver, 74% had completely normal liver enzymes.

Even among those with advanced fatty liver, nearly 6 in 10 had normal liver enzyme levels. The group also had a high burden of obesity, diabetes and abnormal cholesterol.

The report analysed preventive health assessments across different age groups. It reached 3.75 million people in 2025 through the Apollo Total Healthcare programme and identified 15,636 NCD cases.

Dr M Irtaza said, “fatty liver is largely a silent disease. In simple terms, it means excess fat has accumulated in the liver, just like fat can accumulate in other parts of the body”.

“For over 80% of patients, there are no symptoms,” he said.

A small proportion may experience pain on the right side of the abdomen, poor appetite or nausea. This also means that a normal Liver Function Test (LFT) does not necessarily rule out fatty liver.

LFTs measure markers such as ALT, AST, bilirubin and albumin, but “a person can have fatty liver while their ALT and AST remain normal”, he said.

How can it be detected?

For people at higher risk, particularly those with diabetes, obesity, hypertension or abnormal cholesterol, Dr Irtaza recommends going beyond a routine blood test.

“An ultrasound can detect fatty liver accumulation, while a FibroScan tells us about the stiffness of the liver and helps assess fibrosis.”

The distinction is important, he said, because the grade of fatty liver does not have a clinical implication on the extent of liver damage.

“A Grade 1 fatty liver can have fibrosis, while a Grade 3 fatty liver may not have fibrosis. The important question is whether there is fibrosis in the liver or not, and to what extent.”

While fat accumulation can often be reversed with lifestyle changes, fibrosis is scarring of the liver and can progress to cirrhosis.

Dr Irtaza also said that 20-30% of the patients they see are lean and thin. Metabolically dysfunctional-associated fatty liver disease is associated with being lean. “You don’t necessarily have to look obese to have an abnormal metabolism,” he said.

The wider health warning

The report also showed that more young people in India are being burdened with health issues.

Among more than 1 lakh people under the age of 30 who underwent health checks, 59% were overweight or obese, 52% had abnormal cholesterol, 69% were deficient in Vitamin D, and 45% had low Vitamin B12.

Among over 20,000 college students screened, two in three already had at least one health finding requiring attention.

Among women, the report found high central obesity by their 40s, a 2.5-fold rise in diabetes around menopause, and a B12 deficiency peaking in their 20s.

Screening also detected breast cancer in 1 in 359 women and cervical cancer in 1 in 422.

The findings were also concerning among India’s working population. In more than 5 lakh corporate health assessments, with an average age of just 38 years, 8 in 10 people were overweight, nearly half had prediabetes or diabetes, and 1 in 4 had high blood pressure.

Guwahati, Trichy, and Madurai were among the cities with high diabetes prevalence, often over 25%. The same cities showed a high incidence of hypertension cases. Showing the double burden, the co-occurrence of both illnesses exacerbates patients’ quality of life.

The report also found that high blood pressure leads to cholesterol issues, followed by liver issues, leading to diabetes.

In a 10-year follow-up of more than 1.79 lakh people, weight and blood pressure were the first markers to worsen, followed by liver health and cholesterol after around three years. Blood sugar later crossed into the abnormal range.

For Dr Irtaza, the message is threefold: prevention through a healthy weight, regular exercise, and a better diet; control of diabetes, blood pressure, and cholesterol; and early detection, particularly in high-risk people.

A normal blood test, he said, should not be the end of the investigation. One should also go for an ultrasound, then a Fibroscan. After that comes the proper treatment and lifestyle changes.