Fatty liver epidemic in India: Four in 10 affected, new Lancet study warns

Nearly 40 per cent of Indian adults may have metabolic fatty liver disease, with many unknowingly progressing to liver fibrosis, as new Lancet-backed data flags a major silent public health crisis

A large new Indian study suggests that nearly four in ten adults may already be living with fatty liver disease linked to metabolic problems such as obesity and diabetes, not alcohol, and most people who have it do not even know it. 

Titled Burden of MASLD and liver fibrosis: evidence from the Phenome India cohort and published in The Lancet Regional Health – Southeast Asia, the study finds that nearly four in ten Indian adults have metabolic dysfunction–associated steatotic liver disease (MASLD), the new medical name for what was earlier called non-alcoholic fatty liver disease. 

The study highlights that an even more worrying finding is that a sizeable proportion of the population already shows signs of liver fibrosis, an early scarring process that can progress to cirrhosis or liver cancer if left unchecked.

 

What is MASLD?

MASLD refers to excess fat accumulation in the liver linked to metabolic problems such as obesity, high blood sugar, insulin resistance, abnormal cholesterol and high blood pressure. Unlike alcohol-related liver disease, MASLD is driven largely by lifestyle and metabolic health. 

Doctors are increasingly concerned because MASLD does not just affect the liver. It often coexists with type 2 diabetes, heart disease and kidney problems, making it part of a much broader metabolic burden.

How widespread is fatty liver disease in India?

According to the study, researchers analysed data from more than 7,700 adults across 27 cities in India. After adjusting for age, they found that 38.9 per cent of participants had MASLD. 

The authors note that this figure is strikingly similar to global estimates but deeply concerning given India’s population size and the country’s rising burden of diabetes and obesity.

Does fatty liver mean serious liver damage has already begun?

The study found that 6.3 per cent of people with MASLD already had significant liver fibrosis, compared with just 1.7 per cent among those without fatty liver. 

Overall, about 2.4 per cent of the entire study population showed evidence of significant fibrosis. Fibrosis matters because it is a strong predictor of future complications. As scarring advances, the risk of cirrhosis, liver failure and liver cancer rises sharply.

Who is at highest risk of MASLD and liver fibrosis?

The study highlights that people with obesity, diabetes and central or abdominal fat were far more likely to have MASLD. Obesity emerged as the strongest risk factor, with the likelihood rising steeply from overweight to severe obesity. 

Age was another important factor. Liver fibrosis clustered in older adults, particularly those over 60 years, and in people with diabetes, among whom nearly one in ten showed fibrotic changes.

Can fatty liver occur in people who are not overweight?

Yes. The study confirmed the presence of “lean MASLD”, where individuals with a normal body mass index still develop fatty liver disease. 

This form is often linked to insulin resistance and hidden visceral fat and is particularly relevant for Indians, who tend to accumulate abdominal fat even at lower body weights.

What happens when fatty liver progresses to fibrosis?

When fat-laden liver cells remain inflamed over time, scarring begins to develop. Fibrosis stiffens the liver and reduces its ability to function. 

Advanced stages can progress to cirrhosis, liver cancer and increased overall mortality, not only from liver-related causes but also from cardiovascular disease. This is why fibrosis, rather than fat alone, is considered the most critical predictor of long-term outcomes.

Can MASLD and liver fibrosis be prevented or reversed?

The study’s authors emphasise that MASLD is highly modifiable, particularly in its early stages. Evidence consistently shows that:

• Weight loss reduces liver fat and inflammation
• Regular physical activity improves insulin sensitivity
• Balanced diets low in refined sugars and ultra-processed foods protect liver health
• Good control of diabetes and cholesterol slows disease progression

The authors argue strongly for routine screening for fatty liver disease. Given how common MASLD is, especially among people with obesity or diabetes, experts suggest that liver health checks should become part of routine metabolic screening. 

Non-invasive tools such as FibroScan can detect fibrosis early, long before symptoms appear, offering a crucial window for prevention and intervention.