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Fatty liver to liver cancer: Risks, habits, and how to protect yourself

You may not feel it, but your liver could be quietly under stress. Fatty liver disease, called metabolic dysfunction-associated steatotic liver disease (MASLD), now affects one in three Indian adults. While it often starts silently, it can slowly progress to more serious stages such as metabolic-associated steatohepatitis (MASH), cirrhosis, and even liver cancer. Doctors warn that everyday habits—what you eat, how much you move, or whether you drink—can make the difference between a healthy liver and a dangerous diagnosis. How fatty liver progresses to liver cancer Fatty liver involves the accumulation of fat in the liver, typically due to metabolic factors. When this progresses to MASH, marked by inflammation and liver cell damage, it significantly raises the risk of fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) - the most common type of liver cancer. "Fatty liver disease refers to the excessive accumulation of fat in liver cells; it has two main types - Non-Alcoholic Fatty Liver Disease (NAFLD), typically associated with obesity and metabolic syndrome, and Alcohol-Associated Fatty Liver Disease, which results from excessive alcohol use. In the early stages, fatty liver disease is not usually serious, but over time, too much fat can cause inflammation, as well as scarring (fibrosis), which can lead to cirrhosis. The longer a person is in a damaged, unhealthy state increases their chances of liver cancer," explained Dr SK Bala, onco-surgeon at The Calcutta Medical Research Institute (CMRI). "Liver cancer incidence is increased in patients with MASLD and it can occur even before cirrhosis sets in. This is because inflammation in liver cells associated with any of the other risk factors like obesity, alcohol consumption, or superadded viral hepatitis can expedite the evolution of cancer," said Dr Vibha Varma, lead liver transplant and hepato-pancreatic-biliary surgeon, Lilavati Hospital, Mumbai. Everyday habits that add to the risk It's not just rare medical conditions that put your liver at risk—daily lifestyle choices play a huge role. Doctors point to common habits that worsen fatty liver and set the stage for cancer: Eating too much sugar, refined carbs, and processed foods Long hours of sitting and lack of physical activity Relying on fried, junk, or fast food high in salt, oil, and preservatives Gaining belly fat, which raises inflammation and cancer risk Drinking alcohol and smoking, which accelerate liver damage Ignoring fatigue, abdominal discomfort, or abnormal test results "Central obesity causes insulin resistance, which is the hallmark of MASLD. Acceleration is brought about by type 2 diabetes due to oxidative stress and increased fat accumulation within hepatocytes," said Dr Varma. Warning signs to watch for Because fatty liver is often silent, it's easy to miss the early warnings. Still, doctors say there are some signals worth paying attention to: Persistent fatigue Upper-right abdominal discomfort Raised liver enzymes on routine blood tests Enlarged liver detected in scans "Initially, fatty liver does not show any symptoms. But as the condition worsens—mostly fatigue, unexplained weight loss, pain or heaviness in the right side of the abdomen, yellowing of the eyes or skin (jaundice), and swelling of the legs or abdomen may appear. People at risk should get liver tests done regularly," said Dr G Swathi, consultant gastroenterology and haematology, CARE Hospitals, Hyderabad. Why regular testing matters Since fatty liver often shows no symptoms in its early stages, regular testing is crucial. Experts suggest simple blood tests, such as liver function tests, can help reveal raised enzyme levels that may indicate trouble. Ultrasound scans can help detect fat build-up and assess liver stiffness. For people with risk factors such as obesity, diabetes, or heavy alcohol use, early testing helps catch the disease before it progresses. "Today, we can detect fatty liver infiltration years before conventional tests flag anything. AI-powered detection of advanced biomarkers reveals the molecular signature of early disease, even when your labs read normal," added Sid Das, founder of (AI-powered platform to analyse genomic data and develop personalized health interventions.) Can fatty liver be reversed? Fatty liver can often be reversed, especially in the early stages, with lifestyle modifications. Before fibrosis sets in, healthy changes can help restore liver function. Dr Varma shared some tips: Lose 5–10 per cent of your body weight to cut down liver fat Follow a Mediterranean-style diet with vegetables, whole grains, fish, nuts, and olive oil Reduce added sugars and sugary drinks Eat more fibre, omega-3s, and antioxidant-rich foods like flaxseeds, berries, turmeric, and olive oil Sleep well and avoid late-night meals Quit alcohol and smoking Keep diabetes, blood pressure, and cholesterol under control with proper treatment "Studies suggest that up to 70–80 per cent of liver cancer cases related to fatty liver disease are preventable through lifestyle changes. By maintaining a healthy weight, eating a balanced diet, exercising regularly, and controlling diabetes, individuals can significantly reduce their risk of fatty liver progressing to cirrhosis and cancer," said Dr Bala.