Daijiworld Media Network – Mumbai

Mumbai, Jun 25: You’ve heard it before - “Don’t judge a book by its cover.” The same holds painfully true in healthcare. Beneath the sculpted abs or lean frames of many seemingly healthy individuals, a silent disease is brewing -Non-Alcoholic Fatty Liver Disease (NAFLD), now more precisely called Metabolic dysfunction-associated steatotic liver disease (MASLD).

It’s a myth that only overweight or obese people suffer from fatty liver. Increasingly, doctors across India-especially in coastal cities like Mangaluru where fitness is on the rise-are reporting cases of "lean NAFLD". These are individuals with a normal BMI who are physically active, yet are diagnosed with fatty liver on routine scans or blood reports.

Lean NAFLD is no less dangerous than the classic form. Studies show 10-20% of NAFLD patients are lean, with even higher rates in South Asia. These individuals carry visceral fat- the deep belly fat that surrounds internal organs- a key contributor to liver fat buildup. They may also suffer from insulin resistance, a silent metabolic glitch.

Another hidden culprit is sarcopenia, or reduced muscle mass. Even with an active lifestyle, lack of muscle paired with internal fat makes the liver vulnerable. Add to that genetic predispositions (especially PNPLA3 mutations), high-fructose diets, and environmental pollutants, and you have the perfect storm.

Most lean NAFLD cases come to light accidentally-during health checkups or due to slightly elevated liver enzymes. Symptoms, if present, are subtle:

• Mild fatigue

• Occasional discomfort on the upper right abdomen

• Slightly abnormal liver enzymes (ALT, AST, GGT)

More advanced cases may present:

• Persistent dull pain near the ribs

• Skin darkening around the neck or armpits

• Small yellowish cholesterol bumps on the eyelids (xanthelasmas)

When inflammation sets in (MASH), there’s a greater risk of fibrosis, type 2 diabetes, and even cardiovascular complications.

Doctors warn that since thin individuals are less likely to be screened for metabolic issues, the disease is often caught late. Ironically, this could lead to worse outcomes than in obese patients.

“Just because you’re slim doesn’t mean your healthy inside,” says Dr. Neel Kamath, a Mangaluru-based hepatologist. “We’re seeing rising cases in young IT professionals, gym-goers, and homemakers who look fit but have fatty liver or even pre-diabetes.”

If you're experiencing vague signs or have a family history of liver problems, don’t ignore:

• Annual liver function tests (LFTs)

• Ultrasound abdomen scans

• Specialized tests like FibroScan (elastography) or NAFLD fibrosis scores if suspicion is high

For lean NAFLD, the goal isn’t weight loss but metabolic balance. Experts recommend:

• Mediterranean-style diet: Fresh vegetables, whole grains, olive oil, lean protein

• Avoid sugars, trans fats, and excess carbs

• Cardio + strength training to build muscle and reduce visceral fat

• Sleep, stress control, and hydration-key for liver and metabolic health

Regular monitoring is essential even if you’re symptom-free. Early diagnosis is the best defence.