Most of us don’t think much about our liver — until something goes wrong. It’s not an organ that gets the spotlight, like the heart or brain. But quietly and constantly, it processes what we eat, drink, and even breathe. And quietly, it can begin to struggle without a single symptom.
What’s changing now is the reason why.
For years, liver disease was mostly associated with alcohol. But alcohol is not the only culprit. Around the world — and very much in India — the bigger concern is fatty liver caused by poor metabolic health. Doctors now call it MASLD: Metabolic dysfunction-associated steat
Not Just About Alcohol
Apollo’s recent Health of the Nation 2025 report, based on data from over 2.5 lakh individuals who underwent preventive health checks, paints a worrying picture: 65% had signs of fatty liver. Even more telling — 85% of those with fatty liver did not consume alcohol. Instead, the drivers were metabolic-related: weight gain, rising blood sugar, blood pressure, and cholesterol.
In fact, among people with diabetes, 82% had fatty liver. Among those who were obese, 76% had the same. Even people with prediabetes weren’t spared — 70% had liver fat building up silently. The liver, it turns out, is less of an isolated organ and more of a mirror reflecting the broader state of our metabolic health.
54% of women had fatty liver before menopause and this jumped to 70% post-menopause — indicating how hormonal shifts can worsen metabolic health and affect the liver.
Here’s how metabolism affects the liver: When we gain weight — especially belly fat (visceral fat) — or when blood sugar and insulin levels rise, the body begins to store more fat. This happens not just under the skin, but also around and inside organs. Fat builds up in liver cells, which triggers low-grade inflammation. What starts as simple fat in the liver can gradually lead to scarring (fibrosis), and eventually cirrhosis, which is permanent liver damage.
Why Routine Tests Aren’t Enough
The other problem is – a substantial percentage (52%) of people with fatty liver had normal liver enzymes. This means that their routine blood reports looked fine, giving no reason for further testing. However, an ultrasound of the liver revealed otherwise. It’s not that liver function tests aren’t useful, but in the early stages of fatty liver, enzymes — alanine aminotransferase (ALT) and aspartate aminotransferase (AST) — can remain completely normal. This means we can’t rely only on blood work. A simple, non-invasive ultrasound, however, can reveal fat accumulation in the liver much earlier, often before any symptoms appear.
The Good News
Fatty liver, if caught early, is reversible. That’s what makes awareness and screening so important. If you have diabetes, dyslipidemia, hypertension, or even just excess belly fat (>90 cm for men, >80 cm for women), it may be time to check your liver. An annual health check that includes both blood work and imaging offer a clearer view.
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“A Preventive Healthcare Initiative by Apollo ProHealth and The Hindu”
Published – April 17, 2025 03:07 pm IST
