The increasing prevalence of non-alcoholic fatty liver disease among India’s youth is a pressing concern that cannot be overlooked, says Dr Ankur Garg, director at Centre for Liver-GI Diseases and Transplantation, Aakash Healthcare, Delhi, in an interview with Ashish Srivastav. Edited excerpts:
How has the prevalence and age distribution of non-alcoholic fatty liver disease (NAFLD) evolved over the years, particularly in the younger population?
NAFLD is emerging as a significant health concern in India, particularly among young adults especially among those who have a desk job. Traditionally associated with older populations, NAFLD is now increasingly being diagnosed in individuals in their 20s and 30s, signaling a shift in the disease’s demographic profile. A recent study published in ‘Nature’ showed 84% of IT professionals suffering from NAFLD. Their age varied from 30s to early 40s.
How does NAFLD progress over time and why is it a silent but serious public health concern?
It often develops silently and progresses without obvious symptoms until significant damage has occurred. It starts with the accumulation of excess fat in liver cells. At this point, the liver is still functioning normally, and many individuals remain unaware they have the condition.
However, if this fat accumulation is accompanied by inflammation and cellular injury, it leads to serious problems. If left unmanaged, NAFLD can progress to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and even liver cancer. Moreover, people with NAFLD face an elevated risk of cardiovascular diseases. What’s worrying is that these liver issues are now showing up more often in younger people, even those who don’t have the usual risk factors like obesity.
In addition to the well-known risk factors, how is NAFLD affecting individuals who are not typically considered at risk?
Although obesity and diabetes are well-established risk factors for NAFLD, the disease is now not confined to individuals with these conditions. A significant proportion of NAFLD cases occur in non-obese individuals highlighting the multifactorial nature of the disease. Apart from traditional risk factors, other mechanisms including genetic predisposition, insulin resistance, and visceral fat accumulation are also at play in non-obese individuals.
What are the early signs and symptoms of NAFLD that people should watch out for?
Many people live with the disease for years without knowing it. When symptoms do appear, they are often vague and nonspecific. Persistent fatigue is a common early complaint, as is a general sense of weakness or malaise. Some individuals may experience discomfort or a dull ache in the upper right abdomen, where the liver is located. In more advanced cases, patients may notice unintentional weight loss, nausea, or a reduced appetite.
How does a sedentary lifestyle, especially prolonged sitting, increase the risk of NAFLD even in those who appear physically healthy?
A sedentary lifestyle with prolonged sitting, lack of physical activity, and minimal energy expenditure, disrupts the body’s natural metabolism and plays a significant role in fat accumulation in the liver, even in individuals who are not obese. Physical inactivity leads to reduced insulin sensitivity, which in turn promotes insulin resistance, a core driver of NAFLD. For people engaged in desk jobs or prolonged screen time, the risk exacerbates since these lifestyle patterns are often accompanied by the consumption of high-calorie, processed foods that are low in nutritional value. There is an urgent need to increase awareness about the risks of sedentary behaviour and unhealthy eating habits.
What preventive measures and screening strategies can help detect and control NAFLD at an early stage?
Regular liver health screenings should be part of primary healthcare, especially for individuals with risk factors like obesity, diabetes, and high cholesterol. Such people should undergo regular check-ups, even if they feel healthy. Equally important is the promotion of preventive health strategies, such as daily physical activity and diets rich in fiber, whole grains, and lean proteins. To formulate policy decisions and intervention programmes, more robust research and data collection are necessary to better understand the spread and characteristics of NAFLD in diverse Indian populations.