Fatty Liver Disease

Fatty liver disease is fat build-up in liver cells. A small amount is harmless, but larger amounts can inflame the liver, progress to fibrosis, and eventually cirrhosis — so this is no longer seen as "harmless." It is now the commonest liver disease in urban India and a major cause of rising liver transplant need.

Two main types

• Non-alcoholic fatty liver disease (NAFLD/MAFLD) — the commonest; linked to obesity, insulin resistance, type 2 diabetes, and the South Asian metabolic pattern.
• Alcohol-related fatty liver.

Who is at risk

• Overweight or large waist size (even at normal BMI — a common South Asian pattern).
• Type 2 diabetes or pre-diabetes.
• High triglycerides, low HDL.
• High blood pressure.
• Sedentary lifestyle.
• PCOS in women.
• Heavy alcohol use — separately or adding to any of the above.

Symptoms

Often none in early stages. Some people have mild right-upper discomfort or persistent fatigue. It's often picked up as an incidental finding on an ultrasound or in mildly raised liver enzymes on a routine blood test.

Tests

• Liver function tests.
• Ultrasound (fat is visible).
• FibroScan (a special ultrasound) or blood-based fibrosis scores — to check whether scarring has started.
• Screening for diabetes, lipids, blood pressure.

Treatment — lifestyle first, and it works

• Lose 7-10% of body weight — gradually — and most fatty liver improves. This is the best-proven treatment.
• Cut alcohol.
• Diet — cut sugar and refined carbs; moderate portions of healthy fats; plenty of vegetables, dals, whole grains (millets, whole-wheat), moderate fruit, nuts.
• Move every day — 150-300 minutes a week of brisk walking or equivalent.
• Treat associated conditions — diabetes, cholesterol, BP.
• Avoid unregulated "liver detox" products. Several have been linked to actual liver injury.
• Specific medicines are now approved in some countries; a Health Expert will guide when needed.

Fatty liver is often dismissed as mild — but it is the front door to serious liver disease. Caught early, the damage is largely reversible; ignored for years, it is not.