World Hepatitis Day: Fatty liver on the rise, worsens hepatitis risk, say AIIMS experts

On World Hepatitis Day, doctors at the All India Institute of Medical Sciences (AIIMS) warned that nearly one in three adults and children in India may be living with non-alcoholic fatty liver disease (NAFLD), now referred to as metabolic dysfunction-associated steatotic liver disease (MASLD).

When a person with MASLD contracts viral hepatitis, particularly hepatitis A or E, the liver’s pre-existing damage increases the risk of severe complications, including acute liver failure.

Under the global theme, ‘Hepatitis: Let’s Break It Down’, the panel emphasised the urgent need to address both MASLD and viral hepatitis, which includes infections caused by hepatitis A, B, C, D and E viruses.

Viral hepatitis, a preventable and treatable condition, claims a life every 30 seconds globally, surpassing the mortality rates of HIV and malaria. In India, approximately 40 million people live with chronic hepatitis B (HBV, prevalence 4 per cent) and 12 million with hepatitis C (HCV, prevalence 1.2 per cent). Hepatitis A and E, transmitted through contaminated food or water, are major causes of acute liver infections, with hepatitis A being a leading contributor to acute liver failure (ALF), particularly in individuals with pre-existing liver conditions like MASLD.

Dr Shalimar, from the Department of Gastroenterology at AIIMS, who was also a part of the panel shared a 2022 population-based study by AIIMS that found that over 60 per cent of adults in urban Delhi and rural Ballabhgarh have NAFLD, with 23 per cent showing elevated liver enzymes and up to 17 per cent signs of liver fibrosis, particularly in urban areas.

“NAFLD is linked to metabolic risk factors like diabetes and obesity,” Dr Shalimar said. “Alcohol consumption has emerged as the primary cause of cirrhosis in India, overtaking hepatitis B and C. This trend is growing swiftly and is increasingly impacting young people and adolescents. At the same time, the share of cirrhosis cases linked to MASLD is also rising significantly,” noted Dr Shalimar.

“Individuals with a family history of NAFLD face a higher risk of developing the condition themselves. Implementing screening methods based on age and body mass index (BMI) can help detect the disease early,” Dr Sagnik Biswas from the Department of Gastroenterology at AIIMS said.

The doctors called for expanded vaccination, improved sanitation, integrated hepatitis care and scaled-up testing and treatment, emphasising the need to break down financial, social and systemic barriers, including stigma, to eliminate hepatitis as a public health threat by 2030.

Punjab, North-East India hotspots

One lakh Indians die annually of liver cirrhosis/liver cancer caused by hepatitis B virus (HBV) alone.

Around 42% of all hepatitis C virus (HCV) and 33% of all HBV infections caused by unsafe injection practices globally.

In India, North-East and Punjab are HCV hotspots.