DR SAURABH BANSAL
Every year on April 19, World Liver Day reminds us to care for one of the body’s hardest-working yet most overlooked organs. The liver works tirelessly every day, processing nutrients, regulating blood sugar, storing energy, producing essential proteins and clearing toxins from the bloodstream. Despite its central role in keeping us healthy, liver disease often remains invisible until it has already progressed. This year, the day must also become an occasion to correct one of the most common misconceptions in public health conversations: blaming fat alone for liver disease. The science is far more complex.
A recent global study published in The Lancet Gastroenterology & Hepatology estimates that 1.3 billion people worldwide were living with metabolic dysfunction-associated steatotic liver disease (MASLD) in 2023, and this number could rise to 1.8 billion by 2050. The increase is driven by rising rates of obesity, diabetes, insulin resistance and sedentary lifestyles, all of which are becoming increasingly common in India. This is a warning we cannot afford to ignore.
India’s silent liver crisis
India is witnessing a rapid rise in metabolic disorders, and fatty liver disease has emerged as one of its most significant yet underdiagnosed consequences. What makes this especially concerning is that many people with early-stage liver disease experience no obvious symptoms. A person may feel perfectly healthy, continue with daily life and yet have fat silently accumulating in the liver. Left unchecked, this can progress to inflammation, fibrosis, cirrhosis and even liver cancer.
In popular discussions, dietary fats are often portrayed as the primary culprit behind fatty liver disease. However, scientific evidence increasingly shows that the bigger issue is excess calorie intake and poor metabolic health, rather than fats in our diet. The liver stores excess energy in the form of triglycerides. When calorie intake consistently exceeds what the body burns, whether from refined carbohydrates, sugary beverages, fried foods or just oversized portions, the liver begins to accumulate fat.
This is why fatty liver disease is closely linked with high blood sugar, elevated triglycerides, obesity, hypertension and physical inactivity. In fact, several meta-analyses have found that people with fatty liver tend to consume more total calories overall, while the percentage of calories from fat, carbohydrates or protein may not differ significantly from healthy individuals.
Moving beyond myths to science-based habits
That said, the type of fat consumed still matters. Fats from nuts, seeds, fish and several vegetable oils with a good or balanced proportion of saturated and unsaturated fatty acids, such as mustard, groundnut and palm oils, are recommended for use in rotation. Mustard oil contains omega-3 fatty acids in the form of alpha-linolenic acid, along with a favourable balance of unsaturated fats, which are known to support lipid health by helping maintain healthier triglyceride and cholesterol levels as part of a balanced diet. Palm oil also contains tocotrienols, which are important members of the vitamin E family with strong antioxidant properties. Emerging evidence suggests that tocotrienols may help reduce oxidative stress and support healthier lipid metabolism, both of which are relevant to liver and metabolic health. The goal, therefore, is not to fear fats but to understand them better.
Dr Saurabh Bansal is a Gastrointestinal, Laparoscopic, Cancer and Robotic Surgery Specialist and Consultant at Apollo Spectra Hospital and National Heart Institute, New Delhi.
