Non-alcoholic fatty liver cases on the rise, say Bengaluru doctors

Doctors in Bengaluru are seeing increasing cases of non-alcoholic fatty liver disease (NAFLD). Many in their 20s and early 30s are being diagnosed with the disease, unlike in the past when the 40-plus age group was the most affected.

Hepatologist Dr Naresh Bhat says he sees about six cases per week now, compared to just two to four cases per month around 20 years ago.

While alcohol use is a major contributor to a fatty liver, NAFLD is emerging as a bigger problem now, doctors say.

Another gastroenterologist says of all liver disease patients he sees now, NAFLD contributes 30 to 40 per cent of cases. "It has nearly doubled over the past decade when the proportion was only 15 to 20%." Studies show that the NAFLD prevalence is higher in urban compared to rural areas, he adds.

"Studies across Indian cities show that 30 to 40% of children are obese now. More food intake, lack of exercise and a sedentary lifestyle all contribute to NAFLD. Those with both obesity and diabetes are more vulnerable."

Dr Bhat says that obesity, poor sleep patterns and metabolic syndrome that involves high blood sugar, cholesterol levels, etc, are three major contributors to NAFLD.

The main intervention for NAFLD is exercise and weight loss, along with sticking to a traditional diet and avoiding processed food. "We may give medicines to reduce fat or prevent fibrosis, but lifestyle change is the main solution."

Early diagnosis

A challenge with fatty liver disease is the absence of symptoms in the initial stages.

Surgical gastroenterologist Dr Govind Nandakumar says that many cases get picked up when the person does an ultrasound as part of a regular health checkup. Given this is not common, the disease is missed in many. "The condition shows up in regular blood tests only after liver fibrosis (scarring) develops," he says.

NAFLD can lead to liver fibrosis and later proceed to cirrhosis and liver failure.

"About 20 to 25% of NAFLD patients go on to develop cirrhosis or liver cancer, which would require a transplant," says Dr Bhat. He now proactively screens those with diabetes, thyroid and obesity so that the person can be advised about lifestyle changes and thus avoid disease progression. "The majority of those I screen already have NAFLD," he says.