Is India facing a fatty liver epidemic? Gastroenterologist explains why young adults are at risk

In India, liver health is shifting from viral hepatitis and alcohol damage to silent threats. According to The Lancet Gastroenterology & Hepatology, about 27% of young Indian adults now have MASLD, formerly NAFLD, including slim urban professionals in their 20s and 30s with metabolic risks. The 2025 Journal of Clinical and Experimental Hepatology notes that about 26% of young Indians have transaminitis, elevated liver enzymes, indicating liver inflammation.

Since the liver is resilient and often doesn’t cause pain until far advanced damage, diagnosis is difficult. “This silent progression can cause young adults to develop fibrosis and cirrhosis, often leaving a transplant as the only life-saving option. are unknowingly moving through stages of fibrosis toward cirrhosis, a state of permanent scarring that often leaves a transplant as the only viable life-saving option,” Dr Akash Gandotra, Consultant – Gastroenterology, Paras Health Panchkula, tells Health Shots.

What causes fatty liver?

The progression from fatty liver to a stage requiring transplant is not inevitable. However, early recognition and management of the condition influence the outcome. Screening also needs improvement, as relying solely on BMI is not effective in the Indian context. Doctors now emphasise non-invasive tests such as the FIB-4 score and FibroScan to detect liver damage before symptoms arise.

The liver repairs itself effectively when the underlying stress decreases. Lifestyle changes remain the most effective approach. Harvard Health guides that losing 7–10% of body weight can reduce inflammation and possibly reverse early damage. Exercising 150–300 minutes per week, along with a balanced, fibre-rich diet, can help prevent disease progression.

Modern hepatology aims to prevent transplants by treating fatty liver as a metabolic warning, not just a lifestyle issue, to improve liver outcomes in India. Regular screening is vital for those with a family history of diabetes or high cholesterol, especially in a generation facing a metabolic crisis.