NEW DELHI: One in three Indians out of 10 can have Non-Alcoholic Fatty Liver Disease (NAFLD), which is emerging as a significant cause of liver disease in the country.
As NAFLD could assume a silent epidemic with community prevalence ranging from 9% to 32%, depending on age, gender, area of residence, and socioeconomic status, the centre on Friday released revised operational guidelines and training module of NAFLD, which is the most common chronic liver disease globally, estimated to affect up to one-third of adults worldwide.
Releasing the two documents designed to improve patient care and outcomes related to NAFLD through informed evidence-based practices, Union Health Secretary Apurva Chandra said India had taken the lead in recognising NAFLD as a significant Non-Communicable Disease (NCD).
India accounts for more than 66% of deaths and contributes high numbers of NCDs globally, and one of the core causes of metabolic diseases is the liver.
Realising the growing burden and urgent need to address it, India became the first to integrate the NAFLD into the National Programme for Prevention and Control of NCDs in 2021.
“NAFLD is rapidly emerging as a major public health concern, closely linked with metabolic disorders such as obesity, diabetes, and cardiovascular diseases. Out of 10, one in three people can have NAFLD, which highlights the impact of the disease,” he said.
NAFLD is a liver disorder caused by the accumulation of excess fat in liver cells, not necessarily caused by significant alcohol consumption. It is usual for the liver to contain some fat.
However, if more than 5% of the liver's weight is fat, it is called a fatty liver (steatosis). NAFLD encompasses a spectrum of conditions, ranging from simple fatty liver (NAFL or simple steatosis) to non-alcoholic steatohepatitis (NASH).
The prevalence of NAFLD is rising alongside other metabolic conditions such as obesity, type 2 diabetes, and cardiovascular diseases, Chandra said.
He noted that many non-communicable diseases (NCDs), such as diabetes, heart disease, and cancer, are linked to liver health, underscoring the importance of maintaining a healthy liver.
Dr. S K Sarin, Director, and Chancellor, of the Institute of Liver and Biliary Sciences (ILBS), Delhi, who was also present at the event and was part of the team of contributors that prepared the two documents, said in India, 30-40 per cent of liver cancer is due to fatty liver.
Officials said that considering the recent evidence-based interventions in the field of NAFLD, there was a dire need to revise the guidelines with updated information for prevention, control, and management to equip medical care providers and help in the prevention and control of NAFLD.
As the prevalence is increasing in developing countries due to changing dietary patterns and sedentary lifestyles, it is essential to identify individuals at high risk for NAFLD, which is crucial for early intervention and prevention, the guidelines said.
The revised guidelines said that among the risk factors are obesity (60 to 90 per cent), metabolic syndromes, which include abdominal obesity, high blood pressure, high blood sugar, and abnormal blood lipid levels (53 per cent), insulin resistance, and type 2 diabetes (40% to 80%), hypertension, sedentary lifestyle; and high-calorie diets, mainly those consuming high in unhealthy fats and added sugars.
Dr Sarin said that diets rich in fruits, vegetables, whole grains, and lean proteins are recommended for prevention.
Regular physical activity, including at least 150 minutes of moderate-intensity aerobic exercise per week and strength training twice a week, is essential.
Additionally, one must minimise sedentary time and strictly avoid alcohol to prevent further liver damage.
The guidelines said these modifications help manage NAFLD and avoid disease progression, supporting overall health and well-being.
Early screening and diagnosis of NAFLD are crucial for timely intervention and preventing disease progression, it added.
Currently, there is no specific medication approved for the treatment of NAFLD. Pharmacological interventions for NAFLD management are still under development, and no particular drug has been approved as a standard treatment.
The guideline also advocates for a multidisciplinary approach, integrating the efforts of healthcare providers from various disciplines to offer holistic care to individuals affected by NAFLD.