It filters your blood, detoxifies harmful substances, and produces essential substances that help your digestion along. The liver truly is a powerhouse, but what happens when it’s not functioning like it’s supposed to? The liver is not only meant for digestion, but it also manages several vital functions, as explained by Dr. Elankumaran, Senior Consultant Gastroenterologist and Liver Transplantation Specialist at Apollo Hospital, Chennai, in a YouTube video published by Apollo Hospitals. These include:

• Metabolising nutrients from the food we eat
• Regulating blood glucose levels by storing and releasing sugar as needed
• Synthesising essential proteins, including those for blood clotting and immunity
• Storing vitamins and minerals such as vitamins A, D, E, K, and iron
• Producing bile to support digestion and fat absorption

According to a 2024 study published by the National Medical Journal of India, the prevalence of NAFLD (Non-Alcoholic Fatty Liver Disease) has been reported to be 9 to 53 per cent.

Dr. Elankumaran mentions that fatty liver is becoming a silent epidemic, largely because it shows no symptoms in its early stages.

“Fatty liver is a condition where an abnormal amount of fat accumulates in the liver. While a small percentage of fat (up to 10 per cent of liver weight) is considered normal, problems begin when this fat content exceeds 15 per cent,” says Dr. Elankumaran.

Based on the extent of fat accumulation, fatty liver is categorised into different grades:

• Grade 1: Fat occupies 15 to 30 per cent  of liver weight
• Grade 2: Fat content ranges from 30 to 50 per cent 
• Grade 3: Fat makes up more than 50 per cent of the liver

This buildup often goes unnoticed for 10 to 15 years, as there are typically no outward symptoms in the early stages. Over time, however, fatty liver can progress and lead to severe complications such as:

• Liver inflammation (steatohepatitis)
• Fibrosis and cirrhosis
• Liver failure
• Hepatocellular carcinoma (liver cancer)

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Warning Signs of Fatty Liver

Fatty liver disease usually does not cause any noticeable symptoms in the early stages. However, symptoms can manifest, such as:

• Chronic fatigue and weakness
• Discomfort or pain (upper right abdomen)
• Unexplained weight changes (especially around the abdomen)
• Loss of appetite (or early satiety)
• Nausea or digestive problems
• High blood sugar levels; linked to insulin resistance
• Swelling in the abdomen (ascites) or legs
• Dark urine and pale stools
• Itchy skin
• Easy bruising or bleeding

Advanced Warning Signs of Fatty Liver

• Mental confusion, trouble concentrating
• Jaundice or yellowing of skin and eyes
• Swollen veins under the skin or in the oesophagus

Related story: Healing Your Liver: Fatty Liver 101

Fatty Liver Trends: Who Is Affected?

Dr. Elankumaran highlights some concerning trends:

• 20 to 30 per cent of people who come for routine ultrasound scans are diagnosed with fatty liver, often unknowingly.
• It is most common in middle-aged individuals leading otherwise active lives, making it harder to detect based on lifestyle alone.
• An increasing number of children are being diagnosed, a worrying sign linked to poor dietary habits and reduced physical activity.
• Individuals with obesity (BMI over 30) are at high risk, though not exclusively.

There is a common misconception that only ‘fat’ or ‘obese’ people tend to get chronic lifestyle ailments, which include fatty liver. On the contrary, lean fatty liver is becoming common in India, according to Dr. Elankumaran, stressing that this makes the condition even more deceptive and dangerous.

7 Common Causes of Fatty Liver

As explained by Dr. Elankumaran, 

• Excessive and continuous intake of alcohol: a major cause of alcoholic fatty liver.
• Pregnancy: mild, temporary fat accumulation can occur, which is usually harmless.
• Uncontrolled diabetes: specifically type 2, increases fat buildup in the liver.
• Poorly managed hypertension (high blood pressure): adds to liver stress.
• Metabolic syndrome: presence of conditions like obesity, insulin resistance, and high cholesterol.
• Sedentary lifestyle: sitting for long hours with little to no physical activity.
• Unhealthy dietary habits: high intake of refined sugar, fried food, and processed items. 

Related story: Everything You Need to Know About the Liver
Diagnosis of Fatty Liver

• Abdomen Ultrasonography: An ultrasound scan of the abdomen is often the first step. It helps detect fatty changes in the liver and is widely available and affordable, though it may not quantify the fat content accurately.
• MRI: An MRI (magnetic resonance imaging) offers a more precise estimate of how much fat is present in the liver. It is especially useful for grading the severity of fatty liver and monitoring changes over time.
• Fibroscan: Also known as transient elastography, measures both the amount of fat in the liver and its stiffness. This is a valuable, non-invasive method to assess the risk of liver fibrosis or scarring.
• Blood tests: Particularly liver function tests (LFTs), are done to check levels of enzymes like ALT and AST. If these are elevated along with a high amount of liver fat, it may indicate a more serious condition called Non-Alcoholic Steatohepatitis (NASH), which involves inflammation and can progress to liver damage.

In select cases, a liver biopsy may be recommended to examine a small tissue sample under a microscope. This test provides definitive information on the type of liver disease, the extent of damage, and whether scarring or cirrhosis is present.

Treatment to Reverse Fatty Liver

• Avoid alcohol completely. Even small amounts can worsen liver damage.
• Follow an active lifestyle with at least 45–60 minutes of aerobic exercise daily (walking, jogging, swimming, etc.) to burn fat and improve liver health.
• Cut down on fried foods, high-calorie items, and refined sugar. These contribute to fat buildup in the liver.
• Increase protein intake to support metabolism and reduce fat accumulation.
• Eat balanced meals with plenty of vegetables, whole grains, and healthy fats.
• Stay hydrated and maintain a healthy weight through consistent lifestyle changes.

For those with Non-Alcoholic Steatohepatitis (NASH), where liver function tests are abnormal: 

“Medicines are required and should be started under a doctor’s supervision,” says Dr. Elankumaran.

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