Fatty Liver Treatment in Gachibowli, Hyderabad: Diagnosis, Diet and Care

Fatty liver means fat has built up in more than about 5% of the liver. When it is linked to excess weight, diabetes, high blood pressure or abnormal cholesterol, doctors now call it MASLD: metabolic dysfunction-associated steatotic liver disease (formerly known as NAFLD). If the fat causes inflammation and liver-cell damage, it is called MASH (formerly NASH). Our article on why fatty liver disease got a new name explains the change.

MASLD is very common in India. The Phenome India cohort found it in about 38% of adults, and in about 57% of adults who have diabetes. Most people with MASLD will never develop serious liver disease. The minority who do are those whose liver slowly builds up scarring (fibrosis), which over many years can lead to cirrhosis or liver cancer.

So treatment has two goals. The first is to find out who has significant fibrosis, because that group needs closer liver follow-up. The second, for everyone, is to treat the causes: weight, blood sugar, blood pressure, cholesterol and alcohol. MASLD is also linked to heart disease, which is the most common cause of death in people with fatty liver, so the whole metabolic picture matters, not just the liver.

Most people with fatty liver have no symptoms. It is usually found by chance, on an ultrasound done for another reason or on a routine blood test showing raised liver enzymes (ALT or AST). Normal liver enzymes do not rule it out.

When symptoms do occur, they are vague: tiredness, or a dull ache or fullness under the right ribs. Clear symptoms such as yellow eyes, a swollen abdomen or easy bruising usually mean advanced disease, which is why checking for scarring early matters more than waiting for symptoms.

The underlying cause is insulin resistance: the body's cells respond poorly to insulin, and the liver stores the excess energy as fat. In India this often happens at a lower body weight than in Western populations, with fat carried around the waist.

Diagnosis answers three questions: is there fat in the liver, is something other than metabolic risk causing it, and how much scarring is present. A liver biopsy is rarely needed; blood tests and scans answer these questions for most people.

This is the staged approach recommended by the 2024 European guidelines (EASL-EASD-EASO) and the American liver society (AASLD). The FIB-4 cut-offs below apply to adults aged 35 to 65; above 65, a lower threshold (2.0) is used for the low-risk band.

Weight loss through diet and activity is the foundation of treatment for every person with MASLD, whatever its stage. The 2024 European guidelines give clear targets: losing at least 5% of body weight reduces liver fat, 7–10% improves inflammation, and 10% or more can improve scarring. For an 80 kg person, 5% is 4 kg and 10% is 8 kg.

Medicines are added for people with MASH or significant fibrosis, or when they also treat a condition you already have, such as diabetes or obesity. Molecule names are given first below; brand names are mentioned only so you can recognise them, not as an endorsement of any manufacturer.

There is no special 'liver diet'. What helps is eating less in total, cutting sugar and refined carbohydrates, and choosing the fats and foods of a Mediterranean-style pattern, which translates well to Indian vegetarian and non-vegetarian cooking. The 2024 European guidelines specifically advise limiting ultra-processed food and avoiding sugar-sweetened drinks, including fruit juice.

Exercise reduces liver fat even without much weight loss. The 2024 European guidelines recommend more than 150 minutes a week of moderate activity (such as brisk walking) or 75 minutes of vigorous activity, plus muscle-strengthening work.

Prevention is the same as treatment, started earlier. Keep your waist size in check (a useful guide for Indian adults is under 90 cm for men and under 80 cm for women), stay active, limit sugar, refined carbohydrates and alcohol, and have your blood sugar, blood pressure and cholesterol checked regularly.

If you have type 2 diabetes, prediabetes or obesity, ask your doctor whether you should be checked for liver scarring with a FIB-4 score. Guidelines recommend this for people with these risk factors, even when liver enzymes are normal.

Most people with fatty liver can be looked after by a physician or diabetologist, because the treatment is mainly treating diabetes, weight, blood pressure and cholesterol. A gastroenterologist or hepatologist (liver specialist) is needed when there is significant scarring or a doubt about the diagnosis.

Look for a process, not a promise. A clinic or hospital that offers a quick 'cure' or a detox package for fatty liver is a warning sign. These questions help you judge any centre:

Dr. Ram Kumar (MBBS, MD Internal Medicine, MPH) assesses and treats fatty liver as part of diabetes and metabolic care at Boston Diabetes Center, Gachibowli, Hyderabad. The practice is close to Kondapur, Madhapur, HITEC City, Nanakramguda, Financial District.

Care works in two steps. First, your metabolic risk factors and fibrosis risk are assessed: blood tests are done at the on-site lab, FIB-4 is calculated at your visit, and ultrasound or liver stiffness scans are arranged through partner facilities. Second, if your fibrosis risk is intermediate or high, or cirrhosis is suspected, you are referred to a gastroenterologist or hepatologist, and your diabetes, weight and lipid care continues alongside their care.

Bring any previous ultrasound reports, liver function tests, HbA1c results and a list of your current medicines and supplements to your first visit. To book, call or WhatsApp the practice using the buttons on this page.