Dry Bihar haunts fatty liver, a disease one in three Indians may have
Bihar has been a dry state since 2016, yet it has just begun hunting for a liver disease that no ban can keep out. The fat that clogs a liver in Patna is the same fat building up in an office worker in Bengaluru, a shopkeeper in Ludhiana or a college student in Kochi, and none of them needs a drink to get it.
Billed as the country’s first statewide fatty liver screening, Bihar’s drive is part of a doorstep campaign Jaanch Evam Uochar, Aapke Dwar as part of Healthy Liver – Healthy Bihar initiative in September which runs until 30 November and covers all 38 districts.
The state aims to screen about six crore people for diabetes, hypertension, common cancers, heart disease, lung disease and fatty liver.
In the first fortnight alone, more than 85 lakh people were screened for non-communicable diseases.
But liver experts underline that Bihar is measuring a problem that clinics from Delhi to Chennai already see every day: fatty liver even in people who barely touch alcohol.
At the HealthWealth Summit 2026 recently, veteran hepatologist Dr S K Sarin, Director of the Institute of Liver and Biliary Sciences, said nearly one in three Indians has fatty liver disease, which feeds diabetes, hypertension, heart disease, cancer and kidney disease.
There is a near explosion of non-alcoholic fatty acids across the country, and it could be a major health challenge for India, where there are already 10.1 crore diabetics and another 13.6 crore have prediabetes, experts say.NO MORE A DRINKER’S DISEASE
For years, fatty liver was assumed to be a drinker’s affliction. The medical label has changed to match reality. Non-alcoholic fatty liver disease (NAFLD) is now increasingly called metabolic dysfunction-associated steatotic liver disease (MASLD).
The latest name points to the real cause, which is how the body handles sugar and fat.
That is why prohibition offers no protection. A Bihar household with no alcohol can still eat fried snacks, sip sugary drinks and sit through long hours at a desk or a screen.
“Fatty liver disease is being increasingly diagnosed in India, even among people who do not drink alcohol,” says Dr Pratap Behera, gastroenterologist with Manipal Hospital in Bhubaneswar. He lists the usual suspects: “fried foods, packaged snacks, sugary drinks and refined carbohydrates,” combined with a sedentary routine.
Insulin resistance, in which the body stops responding properly to insulin, sits at the centre of the problem. Excess abdominal fat, type 2 diabetes, high cholesterol and high blood pressure raise the risk further.
The assumption that only heavy or older people are affected is also breaking down.
“Fatty liver is no longer restricted to older or overweight individuals; even lean individuals and younger adults in India are increasingly being diagnosed with the condition,” said Dr Vikas Jindal, gastroenterologist with CK Birla Hospital in Delhi.SCREENING BEFORE SYMPTOMS
The case for a statewide drive rests on how quietly the disease develops. Dr Jindal says it “is often asymptomatic in its early stages and may go undetected until it progresses to inflammation, liver fibrosis or cirrhosis.” By the time a patient feels unwell, the damage may already be hard to reverse.
Early detection is cheap compared with that outcome. Dr Behera advises anyone with diabetes, obesity or high cholesterol to ask a doctor about liver tests, adding that “early detection can help prevent further liver damage.”
Dr Jindal argues for screening that targets people with metabolic risk factors, alongside “regular exercise, weight management and a balanced diet.”
Bihar’s campaign bundles liver checks with tests for conditions that share the same roots. Someone who comes in for a blood sugar reading can be assessed for liver fat in the same visit. That is a practical way to reach people who would never book a liver test on their own.
The harder part comes after the screening camps are wrapped up.
Finding fatty liver is simple – getting a person to change what they eat and how much they move is not, say experts.
"Doctors can offer little beyond gradual weight loss, fewer sugary drinks and more vegetables, whole grains and fibre. Bihar’s real test is whether its health system can turn a positive result into that change, village by village, ”said an epidemiologist with the All India Institute of Medical Sciences (AIIMS), New Delhi.- Ends
