What is the prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) in the Indian population?

Prevalence of Non-Alcoholic Fatty Liver Disease in the Indian Population

The prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) in the Indian population ranges from 9% to 32%, with India scoring the highest on the global NAFLD policy preparedness index (42.7 out of 100) despite still having significant gaps in addressing this public health challenge. 1

Epidemiology of NAFLD in India

General Population Prevalence

• Epidemiological studies suggest NAFLD prevalence of approximately 9-32% in the general Indian population 2
• A rural community study in Haryana, India found a prevalence of 30.7% among adults aged ≥35 years 3

High-Risk Groups in India

NAFLD prevalence is significantly higher in certain populations:

• Individuals with overweight or obesity 2
• Patients with diabetes or prediabetes 2
• Nearly half of Indian patients with NAFLD have evidence of full-blown metabolic syndrome 2

Risk Factors for NAFLD in Indian Population

Metabolic Risk Factors

• Hypertension (adjusted OR: 2.3) 3
• Increased waist circumference (adjusted OR: 4.9) 3
• Abnormal HDL levels (normal HDL is protective with adjusted OR: 0.4) 3
• Type 2 diabetes mellitus (high association) 4

Demographic Factors

While not specific to India, global data shows:

• Age: Prevalence increases with age 1
• Gender: Male sex is associated with higher prevalence (globally 31% in men vs 16% in women) 1

Clinical Significance in India

NAFLD in India is associated with:

• Being an important cause of unexplained rise in hepatic transaminases 2
• Contributing significantly to cryptogenic cirrhosis cases 2
• Being linked to cryptogenic hepatocellular carcinoma 2
• High prevalence of insulin resistance 2

Global Context

India's NAFLD situation should be viewed in the global context:

• Worldwide prevalence of NAFLD ranges from 6.3% to 33% with a median of 20% 1
• NASH (Non-Alcoholic Steatohepatitis) prevalence is lower, ranging from 3-5% globally 1
• India scored highest (42.7/100) on the NAFLD policy preparedness index, followed by the UK (40.0/100) 1
• Despite having the highest score, India still lacks a comprehensive national strategy specifically for NAFLD 1

Diagnostic Challenges

• Imaging modalities are not useful in differentiating simple steatosis from NASH in Indian patients 2
• Liver biopsy may be necessary for those with risk factors for significant liver disease 2
• Aminotransferase levels alone are insufficient for diagnosis as they can be normal in individuals with NAFLD 1

Treatment Approaches in Indian Context

Pilot studies in India have shown effectiveness of:

• Weight reduction and exercise 2
• Ursodeoxycholic acid 2
• Metformin 2
• Vitamin E 2
• Pentoxyfylline 2

However, larger randomized controlled trials with histological endpoints are needed to assess efficacy of these interventions in the Indian population 2.

Public Health Implications

• NAFLD is already a significant public health problem even in rural parts of India 3
• Urgent public health interventions are required to prevent NAFLD development by controlling cardiometabolic risk factors 3
• India needs a multi-disciplinary approach involving hepatologists, internists, cardiologists, and endocrinologists 4

The high prevalence of NAFLD in India represents a significant public health challenge that requires targeted interventions focused on metabolic risk factors and increased awareness among healthcare providers.