While alcohol is known to damage the liver, less activity coupled with a high intake of carb and fat food is silently driving an epidemic of nonalcoholic fatty liver disease in India, said experts here on the occasion of International NASH Day on June 8.

Fatty liver disease of two types: If there is fat, but no damage to the liver, the disease is called nonalcoholic fatty liver disease (NAFLD). If you have fat in your liver plus signs of inflammation and liver cell damage, then it is called nonalcoholic steatohepatitis (NASH).

Speaking to IANS, Dr. N Murugan, Hepatologist and Transplant Physician, at Apollo Hospitals said: "NASH is among the fastest-growing reasons for liver transplants across many developed and developing nations. It is known as a silent liver disease because most often there are no obvious symptoms."

"We are used to hearing about alcohol-related liver damage; however, (non-alcoholic) fatty liver disease is now steadily becoming a leading contributor to cirrhosis, liver transplantation, and mortality," he added.

While globally the prevalence of NAFLD is estimated to be around 25 per cent (22-28 per cent), the prevalence in Asia is around 27 per cent (22-32 per cent).

"However, we have seen the trend to be much higher in India with prevalence among adults at 39 per cent and among children at 35 per cent," Dr. Murugan said. The condition is even more severe among individuals who are obese or diabetic.

"In India, the prevalence of NASH is up to 8 per cent in non-obese individuals and up to 45 per cent in obese individuals with body mass index over 30 and diabetics up to 52 per cent," Dr Sushrut Singh - Additional Director, Gastroenterology, Fortis Hospital Noida, told IANS.

Being overweight or having diabetes are the two most major risk factors for fatty liver disease. In addition, people suffering from dyslipidemia (abnormal triglyceride or cholesterol levels), or hypertension are also showing increasing cases of fatty liver.

"A major contributor to NAFLD in India is the metabolic risk factors related to an inactive lifestyle and a high consumption of calories, especially carbs and fats," Dr. Murugan said.

"Belly fat is another key indicator -- if your waistline is more than 80cm for women or more than 90cm for men, it is important to modify your diet and lifestyle," he added.

The doctors lamented that the cases of NAFLD leading to transplant are almost on par with alcoholic liver disease-led transplants.

However, "more alarming is the lack of awareness among the public, which limits the efforts made into its prevention at an early stage," the health experts said.

"NASH continues to destroy the liver silently. Since it causes significant liver damage, sometimes irreversible, even before symptoms arise, it is called a silent killer/epidemic," said Dr Singh.

"So, to tackle this epidemic in India, stringent testing in high-risk groups is mandatory to identify this silent killer at an early stage when it can be managed mostly by dietary and lifestyle changes," he added.