Pune: India is witnessing a silent but alarming shift in public health. On World Liver Day today, hepatologists warned that non-alcoholic fatty liver disease (NAFLD) — recently renamed metabolic dysfunction-associated steatotic liver disease (MASLD) — is rapidly rising among children and adolescents, and no longer remaining a condition confined to sedentary adults.Dr Prateek Agarwal, a paediatric gastroenterologist at Surya Mother and Child Super Speciality Hospital, said that MASLD is now the most common chronic liver disease in children. “Some reports suggest that 35% of Indian children may currently have fatty liver disease,” he said. “While the burden is significantly higher among children with obesity, it is often missed in visibly healthy children. We are seeing a ‘lean’ form of the disease, where a child appears slim but carries harmful visceral fat and insulin resistance that drives fat deposition in the liver.“Experts describe the condition as a “ticking time bomb” because it is often symptomless. If left unchecked, paediatric fatty liver can quietly progress to severe conditions such as cirrhosis and early-onset diabetes.Dr Sahil Rasane, consultant gastroenterologist at KEM Hospital, Pune, said that the warning signs are often subtle. “In India, children can develop fatty liver even without appearing overweight—a condition termed ‘lean nonalcoholic steatohepatitis.’ The real indicators are unhealthy lifestyles and subtle skin changes. The solution, however, remains simple: less junk food, more playground time, and reduced screen exposure.“The causes extend beyond mere calorie counting. Dr Pramod Katare, hepatologist at Noble Hospitals and Research Centre, describes a “biological perfect storm” involving sedentary habits, insulin resistance, and “leaky” gut microbiomes. This combination leads to chronic inflammation that hits the developing liver hard, eventually resulting in liver fibrosis.Despite the alarming trends, there is significant room for optimism. Unlike many chronic conditions, MASLD in children is often reversible if caught early.“Lifestyle modification remains the cornerstone of treatment,” said Dr Baset Hakim, a general physician at Apollo Clinic. “A structured approach, including balanced nutrition, reduced intake of sugary and processed foods, and regular physical activity, can significantly reduce liver fat. Even a modest weight reduction of 5% to 10% can normalise liver function and prevent the progression to severe stages like fibrosis or cirrhosis.“As India faces a potential surge in chronic liver disease starting in childhood, experts agree that early screening and urgent lifestyle interventions are no longer optional—they are essential.
