Fatty liver disease is increasingly being recognised as an important health concern in India. Changing dietary habits, sedentary lifestyles, rising obesity, and an increase in metabolic conditions such as diabetes and high cholesterol are contributing to its growing prevalence. Earlier, fatty liver was commonly associated with alcohol consumption, but today, many people who do not consume alcohol are also being diagnosed with the condition. This form is commonly known as metabolic dysfunction-associated steatotic liver disease (MASLD), previously referred to as non-alcoholic fatty liver disease (NAFLD).
The growing concern around fatty liver has gained attention following reports highlighting that approximately four in every ten Indians may be affected by the condition. This makes awareness, timely diagnosis, and regular monitoring important, particularly among individuals with metabolic risk factors. Health Aaj Kal spoke with Dr Ankur Garg, Group Director & HOD, Liver Transplant & GI Surgery, Paras Health, Gurugram, on how fatty liver can progress to liver cancer, the warning signs to watch for, and what people can do to protect their liver health.”
1. How can fatty liver progress to liver cancer?
Dr Ankur Garg: Fatty liver occurs when excess fat accumulates in liver cells. In many individuals, the condition remains at an early stage and may not cause significant liver damage. However, in some cases, continued fat accumulation can lead to inflammation, a condition known as steatohepatitis. Persistent inflammation may result in fibrosis, which refers to the formation of scar tissue in the liver. In advanced stages, this can progress to cirrhosis, where healthy liver tissue is gradually replaced by scar tissue.
Cirrhosis is an established risk factor for hepatocellular carcinoma (HCC), the most common type of primary liver cancer. Some individuals with metabolic fatty liver disease may also develop liver cancer without previously diagnosed cirrhosis, although this is less common. It is important to understand that fatty liver does not automatically lead to cancer. The progression depends on several factors, including the extent of liver damage, metabolic health, and other associated conditions.
2. What signs should people look out for?\
Dr Ankur Garg: One of the challenges with fatty liver is that it often does not produce noticeable symptoms, particularly during its early stages. Many individuals discover the condition during routine health check-ups or abdominal ultrasound examinations.
Some symptoms that may require medical evaluation include persistent fatigue, discomfort in the upper right side of the abdomen, unexplained weight loss, loss of appetite, and general weakness. In more advanced liver disease, symptoms such as yellowing of the eyes and skin, abdominal swelling, and swelling in the legs may also occur. These symptoms are not specific to fatty liver or liver cancer and should be assessed by a medical professional.
3. When should someone seek medical care?
Dr Ankur Garg: Individuals with diabetes, obesity, high cholesterol, high blood pressure, or a family history of metabolic disorders should discuss their liver health with a doctor. People already diagnosed with fatty liver should also follow medical advice rather than ignoring the condition because they do not experience symptoms.
Doctors may recommend liver function tests, blood sugar assessments, lipid profiles, and abdominal ultrasounds. Depending on the findings, additional investigations such as FibroScan or other non-invasive tests may be advised to assess liver stiffness and identify fibrosis. Further evaluation may be required if there are signs of advanced liver damage.
4. Can fatty liver be managed and its progression reduced?
Dr Ankur Garg: Early identification and appropriate lifestyle changes can help manage fatty liver and reduce the risk of further liver damage. Maintaining a healthy body weight, following a balanced diet, limiting sugary beverages and highly processed foods, and engaging in regular physical activity are important steps. People with diabetes and high cholesterol should also ensure that these conditions are managed under medical supervision.
Ultimately, fatty liver should not be ignored, even when it does not cause immediate discomfort. While not every person with fatty liver will develop advanced liver disease or liver cancer, understanding the risk factors, getting timely medical advice, and following a consistent approach to liver health can help reduce the chances of disease progression.