Indians at Higher Risk of Fatty Liver Disease: Cardiologist Explains Causes and Prevention

Indians at Higher Risk of Fatty Liver Disease: Fatty liver disease, medically referred to as non-alcoholic fatty liver disease (NAFLD), is emerging as a significant health concern in India. Characterized by the accumulation of excess fat in the liver in individuals who drink little to no alcohol, NAFLD is often silent in its early stages but can progress to serious liver conditions, including cirrhosis and liver failure if left unmanaged. Alarmingly, various studies suggest that 35–40% of Indian adults may be affected, making it a pressing public health issue.

Dr. Alok Chopra, a cardiologist and functional medicine expert with over 40 years of experience, emphasizes that Indians are uniquely predisposed to NAFLD, with prevalence rates nearly three times higher than many other ethnic groups. According to Dr. Chopra, this heightened susceptibility is not just due to lifestyle factors like diet and sedentary habits but is also rooted in deep evolutionary and genetic adaptations.

Genetic Predisposition in Indians

In a February 2 Instagram clip, Dr. Chopra explained that populations from the Indian subcontinent—including India, Pakistan, Bangladesh, and Sri Lanka—carry genetic traits developed over generations to survive periods of famine. These adaptations, while beneficial in historical contexts, now make modern individuals more prone to metabolic disorders such as fatty liver disease.

The body of an individual with these genetic adaptations tends to store fat efficiently during times of food abundance, a trait advantageous in historical periods of scarcity. However, in today’s environment of high-calorie diets and reduced physical activity, these adaptations become maladaptive, increasing fat deposition in the liver and raising the risk of NAFLD.

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Lifestyle Factors Contributing to Fatty Liver

While genetics play a significant role, Dr. Chopra highlights that modern lifestyle habits exacerbate the risk. Key contributing factors include:

1. High-Calorie Diets: Frequent consumption of refined sugars, fried foods, and processed meals leads to fat accumulation in the liver. Traditional Indian diets, high in carbohydrates and saturated fats, can further amplify the risk.
2. Sedentary Lifestyle: Urbanization has led to reduced physical activity among Indians. Lack of regular exercise contributes to insulin resistance, a major driver of fatty liver disease.
3. Obesity and Overweight: Excess body weight, particularly central obesity, is strongly associated with NAFLD. Even people with a normal BMI can be at risk if they carry excess abdominal fat.
4. Diabetes and Insulin Resistance: Individuals with type 2 diabetes or metabolic syndrome are more susceptible to developing fatty liver. Insulin resistance prevents proper fat metabolism, allowing fat to accumulate in liver cells.

Early Symptoms and Detection

One of the challenges with NAFLD is that it often remains asymptomatic in early stages. Many people may have fatty liver without knowing it. Common early signs can include:

• Mild fatigue or lethargy
• Discomfort or mild pain in the upper right abdomen
• Elevated liver enzymes detected during routine blood tests

Dr. Chopra recommends that adults above 30, especially those with obesity, diabetes, or a family history of liver disease, undergo regular liver function tests and ultrasound screenings. Early detection is crucial for effective intervention and preventing progression to non-alcoholic steatohepatitis (NASH), fibrosis, or cirrhosis.

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Preventive Measures and Reversal Strategies

The good news, according to Dr. Chopra, is that NAFLD is largely preventable and reversible if addressed early. He outlines several strategies to protect liver health:

1. Dietary Adjustments

• Reduce refined carbohydrates: Cut down on sugary foods, soft drinks, and white flour products.
• Increase fiber intake: Foods like vegetables, whole grains, and legumes aid in fat metabolism and improve insulin sensitivity.
• Include healthy fats: Omega-3 fatty acids found in fatty fish, flax seeds, and walnuts may reduce liver fat.
• Moderate protein intake: Lean protein from fish, eggs, and legumes helps maintain muscle mass and supports metabolism.
• Avoid alcohol: Even moderate alcohol consumption can worsen fatty liver progression.

2. Regular Physical Activity

• Aim for at least 150 minutes of moderate-intensity exercise per week, such as brisk walking, swimming, or cycling.
• Include strength training to build lean muscle mass, which improves metabolic health and fat utilization.
• Small lifestyle changes, like taking stairs instead of elevators and walking during breaks, can make a significant difference over time.

3. Weight Management

• Even 5–10% weight loss can significantly reduce liver fat and improve liver function.
• Sustainable approaches, rather than crash diets, are recommended to maintain long-term benefits.

4. Medical Management

• Individuals with diabetes, high cholesterol, or high blood pressure should work closely with healthcare providers to manage these conditions, as they increase the risk of fatty liver disease.
• Certain medications may be prescribed under medical supervision to help reduce liver fat in advanced cases.

5. Routine Monitoring

• Periodic liver function tests, imaging studies, and metabolic health assessments help track liver health and ensure interventions are working.