Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver condition worldwide, affecting an estimated 25–30% of the global adult population, with rising prevalence in India linked to increasing rates of obesity, type 2 diabetes, and metabolic syndrome. NAFLD encompasses a spectrum from simple steatosis — accumulation of fat in more than 5% of hepatocytes — to the more aggressive form, non-alcoholic steatohepatitis (NASH), which is characterised by inflammation, hepatocyte ballooning, and progressive fibrosis. Approximately 20–25% of NASH patients develop cirrhosis over 15–20 years, and NAFLD-associated cirrhosis is now one of the leading indications for liver transplantation globally.

Most patients with NAFLD are asymptomatic in the early stages, and the condition is frequently discovered incidentally through elevated liver enzymes or a fatty liver on ultrasound during routine health checks. As NASH progresses, patients may experience fatigue, right upper abdominal discomfort, and symptoms of metabolic comorbidities. Diagnosis is established with ultrasound or MRI, liver enzymes, and — for staging of fibrosis — non-invasive tests such as FibroScan (transient elastography) or, when required, liver biopsy. Risk stratification using the FIB-4 index and NAFLD fibrosis score helps identify patients at risk of advanced fibrosis.

Currently, no pharmacological therapy is specifically approved for NAFLD, though several are in late-phase clinical trials. The primary and most effective treatment remains weight loss of 7–10% of body weight through dietary modification and aerobic exercise, which can reduce hepatic steatosis, inflammation, and even early fibrosis. Management of associated conditions — diabetes, dyslipidaemia, and hypertension — is essential. Bariatric surgery is highly effective for obese patients with NAFLD/NASH. For patients who progress to end-stage NASH cirrhosis, liver transplantation offers the only curative option, with outcomes comparable to other transplant indications when metabolic comorbidities are well managed.