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Why fatty liver cases rose in 2024: What are bigger triggers than alcohol?

Dr SK Sarin, Director, Institute of Liver and Biliary Sciences, on easy changes to protect your liver

The wrong diet and lifestyle are bigger triggers for fatty liver than alcohol.

With India already bearing a high disease burden because of obesity, diabetes and heart disease, another condition that co-exists and develops with these is quickly posing a new health hazard. That’s called non-alcoholic fatty liver disease or NAFLD, when fat builds up in the liver in non-drinkers, inflaming and scarring it, resulting in serious damage if untreated over time.

“Almost one in three to four people in India have fatty liver,” says Dr SK Sarin, Director, Institute of Liver and Biliary Sciences, who prepared the Health Ministry’s recent “Operational Guidelines and Training Module of Non-Alcoholic Fatty Liver Disease.” This preventive module has been drawn up to detect the condition early, when it is mostly asymptomatic, and prevent it from becoming the next big public health concern. NAFLD is now being detected across age groups. Fatty liver and liver disease have become as common, if not more, than heart disease.

“We did a survey in Delhi among 6,000 people going to mohalla clinics. Almost 57 per cent of them had fatty liver. Of those who had fatty liver, 11 per cent were lean or had normal weight,” says Dr Sarin. This means that NAFLD could be assuming the status of a silent epidemic with community prevalence ranging between nine and 32 per cent, depending on age, gender, area of residence and socio-economic status.

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What has the profile of NAFLD patients been in 2024?

Up to 10 per cent of new patients being admitted at Institute of Liver and Biliary Sciences (ILBS) had fatty liver. The age group is younger now, less than 40 years. NAFLD is now more common among IT sector professionals and desk workers for three reasons: they work late, they eat late and binge-drink often. They complain of fatigue, which they wrongly attribute to stress when it is their eating and drinking habits that are the real triggers.

What are common causes of NAFLD among Indians?

Being overweight or obese. Anybody who has a metabolic syndrome or a cluster of conditions, including blood pressure, high triglycerides, high cholesterol, high blood sugar and obesity. Eating a diet high in sweets, starchy items and processed snacks can lead to NAFLD.

Fatty liver is present in 85-90 per cent of diabetics as well as those with obesity. To begin with, anybody who is overweight must lose the kilos and get back in range. The formula for weight is very simple: Height minus 100 cm for men and height minus 105 cm in women.

First, lose extra weight with the right exercise and diet. If you have a family history of diabetes, obesity or blood pressure, then reduce another 5 kg. People who are overweight or obese should aim to lose 7-10 per cent of their weight in 2025 and those who are of normal weight should aim for 3-5 per cent if they already have fatty liver. Exercising becomes important because even if you do not lose adequate weight, it will remove the fat and you will become healthier.

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How a good diet, exercise and sleep can become a game changer

The wrong diet and lifestyle are bigger triggers for fatty liver than alcohol. Have a low calorie diet between 1,200 to 1,400 calories. Extra sugar goes to two places. One from the gut into the liver, second into the muscle. If muscles are not moving, the sugar is by and large directed to the liver, which converts extra sugar into fat.

If you have fatty liver, about 40 to 50 per cent of the meals you have daily should be uncooked. I myself mostly rely on raw vegetable salads and fruits in my meals. Opt for millets and discard anything which is made up of fructose. Corn syrup has 50 to 60 per cent fructose, which is extremely harmful for fatty liver. Fruit juices, colas and dressings, all have corn syrup. Take low-sugar fruits like guava, apple or maybe papaya.

How important is sleep?

Sleeping on time is important because if you sleep anytime between 2 am and 6 am, chances of obesity increase by 35 per cent. So sleep on time and get your seven hours.

How does fatty liver impact other organs?

If the person has advanced fatty liver, like grade 2 or 3, they become more prone to developing gall bladder stones. The risk of cancer goes up steeply. Liver cancer is the second most common cause of cancer deaths in the world, as per WHO, and fatty liver is probably the commonest cause. About 39 per cent of liver cancer patients are diabetics too. Cirrhosis and liver cancer are about four times more common in patients with diabetes and fatty liver. About 15 to 20 per cent of fatty liver patients have cardiac events, what we call MACE (Major Adverse Cardiac Events) every year. The fat from the liver gets deposited in the heart.