• The Union Health Ministry released the revised Operational Guidelines and Training Module of Non-Alcoholic Fatty Liver Disease on September 27. 

• One to three of 10 people are being diagnosed with NAFLD, which is rapidly emerging as a major public health concern closely linked with metabolic disorders such as obesity and diabetes, Union Health Secretary Apurva Chandra said .

• He said India has taken the lead in recognising it as a major Non-Communicable Disease (NCD).

Non-Alcoholic Fatty Liver Disease (NAFLD)

• Non-Alcoholic Fatty Liver Disease (NAFLD) is the build-up of extra fat in liver cells that is not caused due to alcohol consumption. 

• It is estimated to afflict approximately one billion individuals worldwide. 

• In some individuals, NAFLD may further lead to liver inflammation, liver fibrosis and cirrhosis, and liver cancer. 

• It is normal for the liver to contain some fat. However, if more than 5-10 per cent of the liver’s weight is fat, then it is called a fatty liver. 

• NAFLD can be further classified into two sub-categories: Non-alcoholic Fatty Liver (NAFL) and Non-alcoholic Steatopatitis (NASH), which are silent diseases with few or no symptoms. 

• Various epidemiological studies from India suggest prevalence of NAFLD around 9-32 per cent of the general population in India.

• Obesity and Diabetes are the major risk factors for NAFLD.

Scenario in India

• Non-Communicable Diseases (NCDs) account for more than 66 per cent of deaths in the country. 

• They are strongly associated and causally linked with major behaviour risk factors such as tobacco use, alcohol use, poor dietary habits, insufficient physical activity and air pollution.

• NAFLD is emerging as an important cause of liver disease in India. It could be assuming a silent epidemic with community prevalence ranging from 9 per cent to 32 per cent, depending on age, gender, area of residence and socioeconomic status.

• India contributes high numbers for NCDs globally and one of the core causes of metabolic diseases is in liver. 

• Realising the growing burden and urgent need to address it, India became the first country to integrate the NAFLD in the National Programme for Prevention and Control of NCDs in 2021.

• Considering the recent evidence-based interventions in the field of NAFLD, there was a dire need to revise the guidelines with updated information for prevention, control and management to equip the medical care providers and help in prevention and control of NAFLD.

• The guidelines focus on health promotion and early detection which are important for ensuring that patients with NAFLD receive timely and appropriate care.

• These documents are designed to improve patient care and outcomes related to NAFLD through informed, evidence-based practices.

• It also advocates for a multidisciplinary approach, integrating the efforts of healthcare providers from various disciplines to offer a holistic care to individuals affected by NAFLD.

National Programme for Prevention & Control of Non-Communicable Diseases

• Non-Communicable Diseases (NCDs) are chronic diseases that are not transmissible from one person to another. 

• Taking this definition into account, NCDs may thus include wide spectrum of medical disorders both acute and chronic like cancers, diabetes, hypertension, Cardiovascular Diseases and stroke, Chronic Kidney Diseases (CKDs), Chronic Obstructive Pulmonary Diseases (COPDs) and Asthma, Non-Alcoholic Fatty Liver Disease (NAFLD), and a gamut of other diseases.

• As per WHO, the NCDs are collectively responsible for more than 74 percent of all deaths worldwide including heart disease, stroke, cancer, chronic respiratory diseases and diabetes.

• These diseases have public health importance globally and in India. 

• NCDs cause significant morbidity and mortality, both in urban and rural population and across all socio-economic strata, with considerable loss in potentially productive years of life. 

• NCDs are also responsible for the maximum out-of-pocket expenditure on health.

• The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched in 2010 in 100 districts across 21 states with an objective to prevent and control major NCDs. 

• The programme was scaled up in a phased manner and now covers all the districts across the country. The focus of NPCDCS was to enable opportunistic screening for common NCDs at District Hospital and Community Health Centres level, through the setting up of NCD clinics.

• Realising the growing burden of NCDs, associated morbidities and mortalities, the government has identified other priority NCD conditions beyond common NCDs and widened the ambit of the programme by including Chronic Obstructive Pulmonary Disease (COPD) and Asthma, Chronic Kidney Disease (CKD), Non-Alcoholic Fatty Liver Disease (NAFLD), Pradhan Mantri National Dialysis Programme (PMNDP).

• The NPCDCS was renamed as National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD).

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