Why is non-alcoholic fatty liver disease emerging as global public health challenge? Experts explain

Metabolic dysfunction-associated steatotic liver disease (MASLD), also known as nonalcoholic fatty liver disease (NAFLD), is a condition of the liver that affects people with excess weight, obesity or other metabolic conditions, including type 2 diabetes, high blood pressure or high cholesterol. The disease is getting more common, especially in Middle Eastern and Western nations, as the number of people with obesity increases.

It is considered the most common form of liver disease in the world, ranging from hepatic steatosis, or formerly fatty liver infiltration or simply fatty liver, to a more severe level of disease known as metabolic dysfunction-associated steatohepatitis (MASH), also known as nonalcoholic steatohepatitis (NASH).

MASH causes the liver to swell and enlarge, a condition medically termed hepatomegaly. The disease triggers fat accumulation within the liver, which directly leads to cellular damage. Over time, MASH can progress to severe liver scarring, known as cirrhosis, or potentially develop into liver cancer. Notably, the resulting injury to the liver tissue closely mirrors the damage typically caused by heavy alcohol consumption.

In its early stages, NAFLD is a "silent" disease that rarely causes noticeable symptoms. If any issues do arise, they generally include fatigue, weakness, or mild pain/discomfort in the upper right side of the abdomen. As the disease progresses into NASH/Cirrhosis, more severe symptoms can develop, including yellowing of the skin or eyes (jaundice), swelling in the legs and belly, severe itching, and spider-like blood vessels under the skin.

Experts explain how NAFLD happens

In response, experts highlighted that the condition is heavily impacting global healthcare, with "as much as 15-20 per cent of liver transplants happening due to NAFLD-related liver failures." They also explain that NAFLD happens when excess fat infiltrates liver cells (hepatocytes), disrupting their normal activity, which causes inflammation and cell damage.

Dr Ankur Garg, Liver Transplant & GI Surgeon, Paras Health Hospital, Gurgaon, said, " To understand non-alcoholic fatty liver disease (NAFLD), we need to have one basic understanding that NAFLD is just like excess fat deposition in liver cells (hepatocytes), similarly as it happens in obesity, where excess fat deposits under the skin and around internal organs. When this excess fat infiltrates hepatocytes, it hampers their normal functioning; not only this, it also leads to inflammation and cell damage due to fatty acid oxidation. Not that being overweight or obese is a criterion to have NAFLD, even normal weight people can have NAFLD, it depends on our lifestyle, choices of foods and very important but not common age-appropriate physical activity. Now, the answer to the above question of why incidence is increasing lies in our life patterns, with increasing urbanisation and more use of packaged food, along with a lack of physical activity is major cause of this, and NAFLD is a silent rising epidemic leading to more and more liver diseases. Today, as much as 15-20% of liver transplants are happening due to NAFLD-related liver failures."

Similarly, Lakshmi Kale, Head Nutritionist at Nutrition In Sync, highlighted the surge in fatty liver diseases over the past few decades. She noted that this disease develops quietly in the body, forcing people to maintain early awareness and take all the more important.

"Fatty liver disease now affects nearly one in three adults worldwide, and the numbers have continued to rise over the past few decades. While that's concerning, it isn't a reason to fear your body. More often than not, fatty liver is the result of everyday modern habits: ultra-processed foods, excess added sugars, poor sleep, chronic stress, and too little movement. It's the liver quietly reflecting the way many of us live today. What makes fatty liver a growing global challenge is that it develops silently. Most people don't experience obvious symptoms until the condition has progressed, making early awareness and prevention all the more important," she said.

She also emphasises that the condition is highly manageable if caught early. The liver possesses a unique and remarkable ability among major internal organs to regenerate and repair itself when given the right support.

"The hopeful part? The liver is extraordinary. Among our major internal organs, it's unique in its remarkable ability to regenerate and repair itself when given the right support. Nourish it with real, whole foods, balanced nutrition, regular movement, restorative sleep, and sustainable lifestyle habits, and in many cases - especially in the early stages - it can reverse fat accumulation and heal. There are no miracle pills or quick fixes. Just small, consistent choices that allow your body to do what it was designed to do. Your body isn't working against you. It's constantly trying to protect and heal you. Give it the right environment, and it will often respond in truly remarkable ways," she added.