Beyond alcohol: Why 40% of Indians have fatty liver and the ‘silent’ risk of fibrosis

“We took up fatty liver as the first condition to analyse because even while we were collecting data and samples, we could see that there was a very high prevalence. The findings are important as they indicate the importance of liver disease, which is not a condition such as heart disease, stroke, or cancer that people often talk about when it comes to managing chronic diseases,” he said.

India’s fatty liver map

The study found 38.9 per cent of the surveyed population had fatty liver, with the prevalence being higher among men at 45.9 per cent compared to 33 per cent women. The lowest prevalence was in Thiruvananthapuram at 27 per cent and the highest in Roorkee and Bhopal at 50 per cent. The prevalence ranged between 37 per cent and 42 per cent in major metropolitan cities such as Delhi, Bengaluru, Pune, Hyderabad, and Chennai.

The study also found that 93.7 per cent of those with fatty liver were obese or overweight as compared to 71.1 per cent across the study. And, the prevalence of fibrosis was also much higher among those with fatty liver — 6.3 per cent as compared to 1.7 per cent across the study.

Importantly, those with fatty liver also had higher HbA1c value — which reflects the blood sugar level over three months — at 6.2 as compared to 5.7 across the study. This indicates that people with fatty liver — usually those who have a lot of fat stored in their abdomen — are more likely to be diabetic.

When it comes to fibrosis — stiffening of the liver tissue due to repeated injuries, making it ineffective — the prevalence was found to be 6.3 per cent among those with fatty liver, 9.1 per cent among diabetics, and 8.1 per cent among those with obesity. This compared to 1.7 per cent across the study population. The prevalence of fibrosis was found to be the highest in Jorhat at 8.3 per cent, followed by Delhi at 4.8 per cent, and Jammu at 4.3 per cent. There may be “possible contributions from specific regional factors such as dietary, genetic, or environmental influences. Lower prevalence of fibrosis in southern and eastern regions may reflect differences in lifestyle, healthcare access, or screening practices.”

Dr Sengupta added: “The Phenome India cohort — the data from which has been used for this study — includes CSIR employees and their families across India. This was done just to ensure easy collection of data over years. However, this mainly represents middle-class urban and peri-urban populations. We do not have data from rural India.”

Need for prevention programme

The high prevalence of fibrosis and fatty liver disease — which in itself may not be of concern but can precipitate fibrosis — means that there is a need to have programmes for prevention, diagnosis, and treatment of the disease, says Dr Shantanu, adding that it is difficult for everyone to get a fibroscan test.

This is the reason he and his team are working with the collected data to figure out a simpler way of screening for the condition. “Using blood biomarkers and details such as age, height, weight etc, we are hoping to develop a way to screen people for fibrosis. It may not accurately diagnose the condition, but it would be an easy way to screen people out so that only those who are likely to have the condition get tested,” he said.