Doctor explains: Why fatty liver is emerging as a major driver of liver cancer in India

For years, fatty liver disease was often dismissed as a harmless finding detected during routine ultrasound examinations. But doctors are now warning that the condition can silently progress into liver inflammation, fibrosis, cirrhosis and, in some cases, liver cancer.

The growing prevalence of obesity, diabetes, sedentary lifestyles and unhealthy dietary habits has transformed fatty liver disease into a major public health concern. Unlike traditional causes such as hepatitis B and C infections, metabolic disorders linked to modern lifestyles are increasingly becoming important contributors to liver damage.

The danger lies in the silent nature of the disease. Many people with fatty liver remain unaware of the condition until significant damage has already occurred. With the liver’s ability to function despite early injury, symptoms often appear only in advanced stages, reducing the chances of timely intervention.

To understand the growing threat of fatty liver disease, its connection with liver cancer and the importance of early detection, Firstpost talked to Dr. Tarang Krishna, Managing Director at Cancer Healer Center, to understand why India needs greater awareness and preventive action against liver-related diseases.

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Why are doctors warning that fatty liver disease can progress to cirrhosis and liver cancer?

Dr Krishna: Fatty liver is no longer considered merely a harmless finding on an ultrasound. In many people, accumulation of fat in the liver can trigger inflammation, which may eventually lead to liver failure and, in some cases, liver cancer.

The major concern is that fatty liver often progresses silently over time, especially when associated with obesity, diabetes, high cholesterol levels and alcohol consumption. What makes it a serious health threat is its scale — many people have fatty liver without even knowing it.

If it is not detected and managed early, a preventable condition can progress into advanced liver disease requiring complex treatment.

How are obesity, diabetes, sedentary lifestyles and alcohol consumption driving India’s rising liver cancer burden?

Dr Krishna: These factors are now among the biggest contributors to liver disease in India. Obesity and diabetes are associated with insulin resistance, fat accumulation and inflammation in the liver. Sedentary lifestyles further worsen weight gain and metabolic imbalance, while alcohol directly damages liver cells and accelerates scarring.

When multiple risk factors occur together, the damage can increase significantly. Earlier, hepatitis B and C infections were considered major causes of liver cancer, but metabolic risk factors and alcohol-related liver disease are becoming increasingly important.

This shift means liver cancer prevention can no longer focus only on controlling viral hepatitis. It must also include lifestyle changes, obesity management and reducing alcohol-related risks.

Why does liver cancer often go undetected and what warning signs should people watch for?

Dr Krishna: Liver cancer often remains undetected because the liver has a large functional reserve. Even when disease begins developing, the liver can continue performing its functions, causing symptoms to appear late or remain vague.

Early signs may resemble common problems such as acidity, weakness or reduced appetite, which people often ignore. Warning symptoms include unexplained weight loss, pain in the upper right abdomen, yellowing of the skin or eyes, dark urine, and swelling in the legs or abdomen.

People with chronic liver disease or diabetes should not wait for symptoms and should undergo appropriate medical evaluation.

Can people who do not consume alcohol still develop severe liver damage and liver cancer?

Dr Krishna: Yes. People who do not consume alcohol can still develop severe liver damage and liver cancer through non-alcoholic fatty liver disease (NAFLD).

This usually occurs when excess fat accumulates in the liver due to obesity, insulin resistance, diabetes, poor diet, high sugar intake and lack of physical activity. In some patients, simple fatty liver can progress to inflammation and scarring.

The risk is increasing among younger adults because unhealthy eating habits and abdominal obesity are becoming increasingly common.

Who should undergo regular liver screening, and which tests can help detect liver disease and cancer early?

Dr Krishna: People at higher risk include those with chronic hepatitis B or C infection, excessive alcohol consumption, diabetes, obesity or a family history of cancer.

Screening generally begins with liver function tests, platelet counts, abdominal ultrasound and regular assessment of liver fibrosis through non-invasive tests.

For some high-risk patients, ultrasound combined with an alpha-fetoprotein (AFP) blood test every six months is recommended for early detection of liver cancer. If a suspicious lesion is identified, further evaluation through MRI or contrast-enhanced scans may be required.

How important are lifestyle changes in preventing liver cancer and reversing liver damage?

Dr Krishna: Lifestyle intervention is one of the most powerful tools for protecting liver health. In early stages of fatty liver disease, weight loss, regular exercise and improved diet can reduce fat accumulation and inflammation, and may even help reverse fibrosis in some cases.

A balanced diet rich in vegetables, whole grains, lean proteins and healthy fats, while reducing sugar, refined carbohydrates, fried foods and processed foods, can significantly benefit liver health.

Regular walking, strength training and maintaining a healthy weight improve insulin sensitivity. Limiting alcohol intake is also extremely important, particularly for people who already have fatty liver disease.

Could liver cancer become a major public health challenge in India if current trends continue?

Dr Krishna: Yes. If current trends continue, liver cancer could become a major public health challenge in India. The combination of fatty liver disease, diabetes, obesity, alcohol use and delayed diagnosis creates a dangerous pathway from silent liver damage to cirrhosis and cancer.

Prevention must begin early through public awareness, targeted screening of high-risk groups and stronger control of diabetes and obesity.

Primary care doctors should also be trained to recognise liver abnormalities as potential warning signs rather than dismissing them as routine findings. The focus should be on early detection, lifestyle correction and long-term monitoring before irreversible liver damage occurs.