An elderly gentleman walked into my clinic with what appeared to be familiar problems. He complained of mild breathlessness while lying down, daytime fatigue, poor control of diabetes and blood pressure despite taking his medicines regularly, and mild forgetfulness. His blood tests showed only mildly elevated creatinine. His liver function tests (LFTs) were almost normal.When I advised an ultrasound of the abdomen and told him, “I want to see how your liver is doing,” he smiled reassuringly. “Doctor Sahab, my liver tests are normal. There can’t be any problem with my liver.” I still insisted on the ultrasound. A few days later, he returned with the report in his hand and a confident smile. “Everything is normal. It only says Grade II–III fatty liver. That’s common. Almost everyone in Kashmir has it.”

His response reflects what many people believe—that fatty liver is common, harmless and not worth worrying about. It is true that fatty liver is common. It is not true that it is harmless.

Epidemic we are ignoringFatty liver disease, now more appropriately called Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), is one of the commonest chronic liver diseases in the world.

Nearly one in every three adults worldwide has fatty liver. In India, studies estimate that about 30–40% of adults are affected, with even higher numbers among people with obesity and diabetes. In Kashmir, where diabetes, obesity and sedentary lifestyles are increasingly common, fatty liver is encountered almost every day in clinical practice. Among older adults with diabetes, nearly 60–70% may have fatty liver.So yes, it is common. But common diseases can still be dangerous. Hypertension is common. Diabetes is common. Heart disease is common. We do not ignore them merely because they are common. Neither should we ignore fatty liver.

Normal liver tests do not rule out fatty liverOne of the biggest myths is that normal LFTs mean a healthy liver.........

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