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India is facing an emerging health threat: the co-existence of Type 2 Diabetes (T2D) and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly called NAFLD. Both these diseases are self-reinforcing and heavily increase the risk of complications like heart disease and liver failure.
To provide a solution to this, Indian researchers have published the first-ever evidence-based guidelines tailored for use among Asian Indians with both T2D and MASLD. These were issued just recently in Diabetes and Metabolic Syndrome: Clinical Research and Reviews.
These guidelines are necessary because Asian Indians show unique metabolic characteristics with higher liver fat deposition than other ethnic groups. India faces a ‘dual epidemic’ of T2D and MASLD, with each condition worsening the other
Dr. Anoop Misra, Chairman of Fortis CDOC Center of Excellence for Diabetes, New Delhi
Why Indian Patients Need Special Attention
Asian Indians are more susceptible to liver fat accumulation than other ethnic groups, reports lead author Dr. Anoop Misra. MASLD has emerged as the leading etiology of chronic liver disease worldwide and affects as many as 88.6% of specific Indian subpopulations
Although MASLD guidelines exist worldwide, none previously considered its management in T2D patients until now.
“While guidelines exist for MASLD globally, none specifically address management in individuals with T2D,” said Dr.Misra, recipient of India’s highest medical honour, the Dr B.C. Roy Award in 2006, and the Padma Shri in 2007.
Key Screening and Diagnostic Recommendations
The revised guidelines recommend regular MASLD screening in all T2D patients, particularly those with risk factors such as obesity and metabolic syndrome.
Physicians should evaluate:
Body mass index (BMI)
Waist circumference
Waist-to-height ratio
They also suggest non-invasive markers such as FIB-4 scoring and liver stiffness measurement to track liver fibrosis.
Clinical evaluation should include BMI, waist circumference and waist-to-height ratio, with non-invasive tests like FIB-4 and liver stiffness measurement to assess fibrosis
Dr.Misra, Head of the National Diabetes Obesity and Cholesterol Foundation (N-DOC).
Food as Medicine: Individualized Diet and Lifestyle Counselling
The prime emphasis of the recommendations is dietary and lifestyle modification, which has been shown to enhance blood sugar and liver health. The proposed nutrition plan is:
50–60% complex carbohydrates
20–30% unsaturated fats
15–20% protein
The recommendations also highly recommend:
Reducing saturated and trans fats
Excluding refined carbohydrates and added sugars
Following a plant-based, high-fiber diet
Including fatty fish (such as salmon, mackerel) for non-vegetarians
“It is crucial to limit oils high in saturated fats (ghee, coconut oil, palm oil, butter, cream, animal fat) and omega-6 PUFAs, as excessive intake has been linked to inflammation and liver fat accumulation,” the experts said.
Excessive intake of ultra-processed foods and recycled cooking oils, prevalent in Indian households, is indicated as unhealthy due to trans and saturated fat composition.
Move More, Drink Coffee, Avoid Alcohol
Other lifestyle recommendations are:
150–300 minutes of moderate physical activity per week, or 75–150 minutes of vigorous physical activity
Abstinence from alcohol
Consumption of coffee (more than 3 cups/day) can enhance liver enzymes and decrease inflammation
A Practical Roadmap for Indian Clinicians
“The guidelines provide clinicians with a practical framework for managing MASLD in people with T2D, accounting for the unique metabolic characteristics of Asian Indians. It offers specific, evidence-based recommendations for screening, assessment frequency, and interventions, with clear algorithms facilitating clinical decision-making,” said Dr. Misra.
Designed with collaboration from the best institutions such as Medanta, Sir Ganga Ram Hospital, and AIIMS, the guidelines give an unambiguous clinical guide. They state when to screen, how to evaluate severity, and when to refer to specialists
(Input from various sources)
(Rehash/Muhammad Faisal Arshad/MSM)
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