In Plain Sight

For decades, liver disease in India has largely been associated with alcohol abuse. That perception is now dangerously outdated. A far greater threat is quietly spreading through our homes, workplaces and schools, fuelled not by alcohol but by expanding waistlines, sedentary lifestyles, diabetes and unhealthy eating habits.

A recent nationwide study published in The Lancet Regional Health Southeast Asia estimates that nearly four out of every ten Indian adults suffer from metabolic dysfunction-associated steatotic liver disease (MASLD), commonly known as fatty liver disease. Even more alarming is that many are already showing signs of liver fibrosis, the irreversible scarring that can eventually lead to cirrhosis, liver failure and liver cancer.

The real danger lies in its silence. Fatty liver disease rarely causes symptoms in its early stages. Routine blood tests may appear normal while irreversible damage continues unnoticed. By the time warning signs emerge, treatment options become limited and expensive.

India's growing burden of obesity and Type-2 diabetes has created the perfect breeding ground for this epidemic. Processed foods, sugar-laden beverages, long working hours, declining physical activity and poor sleep have become defining features of modern life. Unfortunately, our healthcare system continues to focus more on treating diseases than preventing them.

The challenge is even more significant in smaller states like Sikkim. Once known for healthier lifestyles, the state is witnessing rising cases of alcoholism, obesity, diabetes and sedentary habits, especially among young people. As urban lifestyles replace traditional diets and physical activity declines, metabolic diseases are becoming increasingly common. Yet liver health remains largely absent from routine health check-ups and public awareness campaigns.

The government must treat MASLD as a national public health priority. Screening for high-risk individuals, particularly those with diabetes, obesity and hypertension, should become part of preventive healthcare. Public campaigns promoting healthier diets, regular exercise and reduced consumption of ultra-processed foods deserve the same urgency as anti-tobacco initiatives.

India cannot afford another silent epidemic. Fatty liver disease is largely preventable and often reversible if detected early. But ignoring it today will translate into soaring healthcare costs, reduced productivity and avoidable deaths tomorrow. Prevention is not merely the better option—it is our only sustainable cure.