Fatty liver disease has quietly become one of the most important causes of liver disease in India and around the world. Earlier, it was mainly associated with alcohol. Today, it is increasingly seen in people who are overweight, diabetic, or living with high blood pressure and high cholesterol. What makes it more worrying is that fatty liver often does not cause symptoms in the early stages and can progress silently over many years.
Fatty liver occurs when excess fat collects inside the liver. Our modern lifestyle has played a major role in its rise. Long hours of sitting, lack of exercise, irregular meals, processed and fried foods, sugary drinks and stress have contributed to increasing obesity, even among young people.
Being overweight is a major risk factor. Diabetes is another. India is often called the diabetes capital of the world, and a large number of diabetic patients also have fatty liver. High blood pressure, high cholesterol, especially LDL, or bad cholesterol, and other metabolic problems further increase the risk.
Fatty liver should therefore never be viewed as just a liver problem. It is usually part of a larger metabolic disorder affecting the entire body. A patient with fatty liver may also have diabetes, high blood pressure and abnormal cholesterol. Treating only the liver while ignoring these conditions is incomplete treatment.
Not every person with fatty liver will develop liver cancer. However, when fat remains in the liver for a long time, it can cause inflammation and progressive scarring. Over time, this may lead to cirrhosis, a condition in which normal liver tissue is replaced by scar tissue and the liver slowly loses its ability to function properly.
People with cirrhosis more commonly develop liver cancer, particularly hepatocellular carcinoma. But we now know that people with fatty liver disease, especially those who also have a hepatitis B infection or advanced fatty liver, can develop liver cancer even before cirrhosis develops. This makes early detection critical. Early detection with the right treatment can lead to the cure of liver cancer.
In India, fatty liver disease is increasingly recognised as a significant cause of liver cancer. Because early fatty liver is silent, many patients reach a doctor only when the disease has already advanced.
Fatty liver usually does not cause symptoms early on. Many people find out only during a routine ultrasound or health check-up. If you are overweight, diabetic, or have high blood pressure, high cholesterol, or a family history of metabolic disease, regular screening is important.
Later, some people may feel tired, have discomfort in the upper right abdomen, lose weight or appetite, or develop jaundice and swelling. An ultrasound is the simplest first test, followed by blood tests and sometimes a CT scan if needed.
The encouraging news is that fatty liver can be prevented and even reversed in its early stages. Losing weight gradually, controlling diabetes, blood pressure and cholesterol, eating fresh home-cooked food and staying active can make a real difference. Cut down on sugar, fried food, processed snacks and sugary drinks. Exercise for at least 30 minutes most days and limit alcohol.
Fatty liver is also linked to heart attack and stroke, so it is important to treat the whole person, not just the liver. If you are overweight, diabetic, or have high blood pressure or cholesterol, get your liver checked. Early action can prevent bigger problems later.
(Dr Dilip Todi is a senior consultant in medical gastroenterology at Narayana Hospital, Howrah.)