In Bhubaneswar, liver specialists convened under India's national hepatology body to draft the country's first comprehensive prevention guidelines for a disease quietly affecting one in three Indians — metabolic dysfunction-associated steatotic liver disease, or MASLD. Once known as non-alcoholic fatty liver disease, it is no longer a condition of the elderly or the affluent; it is appearing with troubling speed in children and young adults. The guidelines represent a collective recognition that the path forward runs not through hospitals alone, but through kitchens, classrooms, communities, a
Odisha leads national push to prevent metabolic liver disease affecting 1 in 3 Indians
Prevention means catching metabolic dysfunction before the liver even starts to fail
Mark
Why does a disease that doesn't involve alcohol get called a liver disease at all? Shouldn't it be classified as a metabolic disorder?
Mimi
That's the naming problem exactly. It was called non-alcoholic fatty liver disease for decades precisely because it wasn't about drinking—but that negative definition made it invisible. MASLD is better because it names what's actually happening: the liver is accumulating fat because of metabolic dysfunction. But the real issue is that people don't think of their liver as something that can fail them quietly, through everyday choices.
Mark
One in three Indians. That's staggering. How did it get this common so fast?
Mimi
Rapid urbanization, dietary shifts toward processed foods, sedentary work, rising obesity rates. These things happened in a generation. The disease was always possible, but the conditions that trigger it became normal.
Mark
You mentioned children. How young are we talking?
Mimi
Young enough that doctors are seeing it in teenagers, sometimes earlier. That's what frightened the experts most—if someone develops MASLD at fifteen, what does their liver look like at forty-five?
Mark
So the guidelines are about prevention. But for someone who already has it, what changes?
Mimi
That's the shift the experts want to make. Right now, medicine waits until the disease is advanced, then tries to manage it. Prevention means catching metabolic dysfunction before the liver even starts accumulating fat—screening people, helping them change diet and activity before damage happens.
Mark
Why does Odisha have nine experts on this task force? Is the disease worse there?
Mimi
That's not entirely clear from what happened. But it suggests Odisha's medical community has been paying attention to this earlier than other states, or has the infrastructure to study it. Either way, it means Odisha will have a voice in shaping how the rest of India responds.
The Pulse
- A disease most Indians have never heard of is already living inside roughly one in three of them, and it is increasingly finding its way into young bodies that should have decades of health ahead.
- The urgency sharpened in Bhubaneswar, where experts confronted not just biology but environment — ultra-processed foods, sedentary habits, and structural barriers that make unhealthy choices the easier ones.
- Nine Odisha-based specialists anchored the national task force, signaling that this state has been grappling with the metabolic liver disease burden with unusual seriousness.
- The draft guidelines map India-specific risks — regional diets, obesity patterns, alcohol and tobacco use — and push screening upstream, before the disease hardens into cirrhosis or liver failure.
- The harder challenge now is execution: whether a fragmented healthcare system can translate expert consensus into coordinated action across clinics, schools, communities, and policy chambers.
In Bhubaneswar, liver specialists convened under India's national hepatology body to draft the country's first comprehensive prevention guidelines for a disease quietly affecting one in three Indians — metabolic dysfunction-associated steatotic liver disease, or MASLD. Once known as non-alcoholic fatty liver disease, it is no longer a condition of the elderly or the affluent; it is appearing with troubling speed in children and young adults. The guidelines represent a collective recognition that the path forward runs not through hospitals alone, but through kitchens, classrooms, communities, and the policies that shape them.
In Bhubaneswar recently, a gathering of India's leading liver specialists set out to write guidelines that could quietly transform the country's relationship with one of its most underacknowledged health crises. Convened under the Indian National Association for the Study of the Liver, the experts worked to finalize the first national framework for preventing metabolic dysfunction-associated steatotic liver disease — MASLD — a condition that affects roughly one in three Indians and is increasingly appearing in children and young adults.
Prof SP Singh, who led the effort, was direct about the shift in who is at risk. MASLD is no longer a disease of age or affluence. It is metabolic — rooted in how the body processes energy — and it creeps in through diet, inactivity, and excess weight. The experts mapped India-specific risk factors, from regional dietary patterns to the realities of obesity across different communities, and built in screening strategies designed to catch the disease before it progresses to cirrhosis or liver failure.
The conversation also moved beyond individual behavior. The guidelines acknowledge that prevention means confronting the food environment itself — the spread of ultra-processed foods, the marketing that promotes them, and the structural conditions that make unhealthy choices the default. Odisha contributed nine members to the national task force, giving the state an unusually strong hand in shaping recommendations that will eventually reach clinics and public health programs across the country.
What remains is the harder work of implementation. The experts were clear that no single actor can carry this effort. Prevention at scale demands coordination among individuals, families, schools, healthcare providers, communities, and policymakers — each layer reinforcing the others. The guidelines offer a practical roadmap. Whether India's healthcare system can follow it is the question that now hangs in the air.
In Bhubaneswar recently, a room full of liver specialists gathered to write something that could reshape how India thinks about a disease most people have never heard of—even though it's silently affecting roughly one in three of them. The meeting, convened under the Indian National Association for the Study of the Liver, brought together leading experts in gastroenterology and hepatology to hammer out the first comprehensive national guidelines for preventing metabolic dysfunction-associated steatotic liver disease, or MASLD. The condition, previously called non-alcoholic fatty liver disease, has quietly become one of the world's most pressing public health problems, and India is no exception.
Prof SP Singh, who led the effort, framed the stakes plainly: this is no longer a disease of the wealthy or the elderly. What troubles doctors most is how rapidly it's appearing in children and young adults—populations that should have decades before worrying about liver damage. The disease creeps in through the everyday choices people make: what they eat, how much they move, whether they carry excess weight. It's metabolic, meaning it's tangled up with how the body processes energy and manages weight, not simply a matter of drinking too much alcohol.
The experts spent their time in that room wrestling with the full landscape of prevention. They mapped out India-specific risk factors—the dietary patterns that matter here, the physical activity levels that are realistic, the particular ways obesity manifests across different regions and communities. They discussed screening strategies to catch the disease early, before it hardens into cirrhosis or liver failure. They looked at alcohol and tobacco use, at how to help people manage their weight, at what healthy eating actually looks like in an Indian context. But they also looked outward, beyond individual behavior. They acknowledged that preventing MASLD means confronting the food environment itself—the proliferation of ultra-processed foods, the marketing practices that push them, the structural barriers that make healthy choices harder than unhealthy ones.
Odisha played an outsized role in this national conversation. Nine experts from the state were part of the task force, giving the state significant representation in shaping guidelines that will eventually guide prevention efforts across the country. This concentration of expertise suggests Odisha has been thinking about metabolic liver disease longer than many places, or perhaps has seen its burden more clearly.
The real work, though, lies ahead. The experts were clear that prevention cannot be a solo act. It requires coordination across multiple layers: individuals making different choices, families supporting those choices, schools teaching children about nutrition and movement, healthcare professionals screening and counseling patients, communities organizing around health, and policymakers creating the conditions that make prevention possible rather than a luxury. The INASL guidelines, once finalized, will serve as a practical roadmap—not a theoretical ideal, but a usable set of recommendations that can actually be implemented in clinics, schools, and public health programs across India. The question now is whether the country's fragmented healthcare system and competing priorities can actually execute what these experts have designed.
Notable Quotes
The overarching objective is to shift the approach from merely treating established liver disease to preventing MASLD and its metabolic complications at an early stage— Prof SP Singh
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