Nearly four in ten Indian adults have metabolic-associated fatty liver disease, according to a large multi-city study published in The Lancet, underscoring the scale of a silent liver disease epidemic
driven by obesity and diabetes.
The findings point to a widespread but largely silent public health problem, with many individuals already showing signs of early liver damage.
The study, based on data from the Phenome India cohort, found that metabolic-dysfunction-associated steatotic liver disease (MASLD) affected over one-third of adults screened across multiple Indian cities, while a smaller but significant proportion had already developed liver fibrosis, a precursor to cirrhosis.
In easy words, metabolic-associated steatotic liver disease (MASLD) is a condition in which excess fat accumulates in the liver due to problems such as obesity, diabetes, high blood sugar, high cholesterol or high blood pressure. The impact on liver is due to other health issues and not alcohol.
Study findings from 27 cities across India
The prospective study recruited 10,267 adults from 27 cities across India through 37 laboratories of the Council of Scientific and Industrial Research between December 2023 and June 2024. After exclusions, data from 7,764 participants were included in the final analysis.
Of those analysed, 3,712 participants fulfilled the criteria for MASLD, translating to a crude prevalence of 47.8 per cent and an age-adjusted prevalence of 38.9 per cent. The study also identified significant liver fibrosis — defined as liver stiffness measurement (LSM) of 8.2 kPa or higher — in 6.3 per cent of individuals with MASLD, compared with 1.7 per cent among those without MASLD. “MASLD affected over one-third of participants,” the authors wrote, adding that “site-specific disparities were observed, which suggest the need for large-scale longitudinal studies to elucidate region-specific risk factors and temporal trends”
Obesity and diabetes drive risk, fibrosis higher in older adults
Participants with MASLD were more likely to be overweight or obese, have higher blood sugar levels, insulin resistance and abnormal lipid profiles. Obesity emerged as the strongest risk factor, with adjusted odds increasing sharply with rising body mass index, the study found. Among people living with diabetes, 66.4% were found to have MASLD, while 9.1% showed evidence of liver fibrosis. Fibrosis was more common in older adults, particularly those over 60 years of age, and among individuals with obesity class II and diabetes.
The authors highlighted the silent nature of the condition, noting that “these figures highlight the subclinical nature of early MASLD and its silent progression, which poses a potential burden to the public health systems if left unaddressed”
Call for screening and public health action
The study observed regional variation in prevalence, with higher rates reported in central, northern and southern regions of India, and called for targeted public health interventions.
“Community-based awareness and targeted public health interventions across diverse geographical and socio-cultural settings in India may help curb the rising burden,” the authors said.
They also advocated policy shifts to include transient elastography-based screening, particularly for urban and high-risk populations, warning that without early detection and management, the burden of MASLD and liver fibrosis could place increasing strain on India’s healthcare system.
