Rising concern: 35 per cent of Indian children affected by fatty liver disease

The AIIMS data underscores the urgent need for targeted interventions to address the growing burden of fatty liver diseases in India.
Image used for representational purposes only
Image used for representational purposes only

NEW DELHI: The prevalence of fatty liver cases is increasing in India, affecting both adults and children. According to a recent study conducted by the All India Institute of Medical Sciences (AIIMS), approximately 38% of the Indian population is afflicted with fatty liver or non-alcoholic fatty liver disease (NAFLD). Of particular concern is the finding that nearly 35% of the cases are among children, now referred to as metabolic dysfunction-associated steatotic liver disease (MASLD). The updated terminology was used to eliminate any stigmatising terms associated with alcohol consumption or the use of the word fatty. The AIIMS data underscores the urgent need for targeted interventions to address the growing burden of fatty liver diseases in India.

NAFLD occurs when too much fat forms in the liver cells. Usually, the liver takes in food directly from the gut. It processes fat, carbohydrates and protein into energy and other proteins, but an imbalance in this process can result in excess fat in the liver. The liver is the body’s largest organ, aiding digestion, energy storage, and toxin removal.

According to Dr Praveen Makhija, principal consultant, paediatrics, Max Smart Super Speciality Hospital, Saket, fatty liver disease occurs when fat builds up in the liver, primarily triglycerides (type of fat) and other lipids, making up about 10% of the liver’s weight, potentially leading to liver damage.

There are two main types of fatty liver – NAFLD, and alcoholic fatty liver disease, mainly caused by heavy drinking. NAFLD is the most common cause of chronic liver disease in young people in both developed and developing countries. In India, its prevalence ranges from 3-10% in normal-weight children to 10-60% in overweight/obese children.

Risk factors and symptoms

It has been seen in children and young adults who have high body mass index (BMI), have central obesity, are insulin resistant, have prediabetes, or have type-2 diabetes. Also, those having abnormal blood lipid levels and metabolic syndrome, including high blood pressure, high triglycerides, and obesity, are vulnerable to this condition. Among girls, in some cases, irregular menstrual periods could be a risk factor, too.

Dr Makhija said sleep apnea and a family history of fatty liver disease are the other risk factors.

Many children with NAFLD have no symptoms, but some may experience fatigue, malaise, pain or discomfort in the upper right abdomen.

According to Dr Kapil Sharma, director of gastroenterology and head of endoscopy at Sarvodaya Hospital, Faridabad, liver diseases like Wilson’s disease, celiac disease, haemochromatosis disease, and hepatitis B and C are some of the other reasons behind the rise in this condition among children.

Dr Neelam Mohan, senior director and HOD, gastroenterology, liver transplant, gastrosciences, Medanta, Gurugram, said they analysed pediatric patients in 2023 and found more than 25% overweight and obese children. Following parents’ consent, 250 obese children were screened for liver tests and fatty liver detection by elastography (fibroscan). They found 23% of these children had fatty liver on fibroscan along with raised liver enzymes.

The main culprit

Dr Mohan said change in lifestyle of children is the culprit for fatty liver disease. “Junk foods, which include processed foods, refined flours, and sweetened beverages, along with reduced activity, exercises, and sports, coupled with increased screen time, is becoming a norm in many children nowadays,” she said, adding that fatty liver disease can progress to fibrosis and cirrhosis over a couple of decades.

According to Dr Arun Gupta, child health and nutrition advocate, a study published in January showed that a higher intake of ultra-processed food products (UPFs) is associated with an increased risk of non-alcoholic fatty liver disease. This indicates that reducing UPF intake has the potential to improve liver health.

This study is backed by a more recent study in May that showed an association of high UPF intake with negative markers of children’s health like high BMI, higher fasting plasma glucose levels, and lower HDL cholesterol levels, said Dr Gupta, who is convener of Nutrition Advocacy in Public Interest-India (NAPi), a national think tank of independent medical experts, paediatricians, and nutritionists.

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