Non-Alcoholic Fatty Liver Disease in Asian Indians:Relationship With Insulin Resistance, Diabetes and Cardiovascular Risk

Prevalence of non-alcoholic fatty liver disease (NAFLD) varies in India; up to one-third of the urban population is affected by the disease. In Asian Indians, presence of NAFLD is driven by multiple factors – presence of excess abdominal fat (abdominal subcutaneous and intra-abdominal fat) and lifestyle factors (imbalanced diets and physical inactivity), and it is correlated closely with insulin resistance, the metabolic syndrome and dysglycaemia in the background of genetic predisposition (investigated genes in Asian Indians: APOC3, PNPLA-3, PPARγ, SREBP-2, adiponectin, SAMM50, PARVB and PZP). Recent studies also show that presence of NAFLD independently correlates with subclinical inflammation and surrogate markers of atherosclerosis (carotid intima-media thickness, impaired flow-mediated vasodilatation) in Asian Indians. A prediction equation (Indian Fatty Liver Index) which includes simple measures has been developed for Asian Indians. On the other hand, increased (more than 15.6 cm) liver span (surrogate marker of fatty liver), in a preliminary study, predicted diabetes in non-obese Asian Indians. Dietary factors are important for the development of NAFLD, and some evidence indicates that regular use of high monounsaturated fatty acid rich oils, and low amount of saturated fat intake are beneficial.