The health ministry on Friday released guidelines to prevent and manage non-alcoholic fatty liver disease (NAFLD) amid concerns that this symptomless disorder and risk factor for cirrhosis and liver cancer affects up to three in 10 Indians.

The guidelines with updated evidence-based interventions on diet, exercise and diagnostic protocols are primarily intended for use by healthcare providers to help prevent or manage NAFLD, which doctors say is a potentially reversible condition in its early stages.

The health ministry said the guidelines and a related training module document are expected to empower healthcare providers with updated knowledge and skills to identify, manage and prevent NAFLD while reinforcing early detection and lifestyle modifications.

The guidelines, prepared by a panel of senior doctors and public health experts, come amid longstanding concerns that NAFLD is a silent epidemic with prevalence levels in the community ranging from 9 per cent to 32 per cent, depending on age, gender, area of residence and socioeconomic status.

They recommend a 5 per cent weight-loss target, daily caloric restriction by 30 per cent, and lowered intakes of carbohydrates and fats for people who have hepatic steatosis, the early stages of liver fat accumulation which is often reversible with weight loss and lifestyle changes.

The guidelines recommend a minimum 7 to 10 per cent weight-loss target along with reduced fat, carbohydrates and sugar intake for people who have progressed to hepatic fibrosis, a condition marked by the emergence of scar tissues because of chronic liver injury.

For lean individuals who have NAFLD, the guidelines recommend maintaining their current weight and a shift to a nutrient-dense diet with complex carbohydrates, lean proteins, healthy fat and reduced free sugar.

The guidelines also recommend the intake of millets and high-fibre food and regular physical activity, including at least 150 minutes of moderate-intensity aerobic exercise per week. Experts say a brisk walk for 30 minutes a day, or 10-minute walks thrice a day for five days, can make the target.

A study by doctors at the All India Institute of Medical Sciences, New Delhi, had last year found that NAFLD accounted for 14 per cent of cirrhosis in a nationwide sample of 41,000 cirrhosis patients from hospitals across India since the mid-1990s. Alcohol accounted for 43 per cent of the cirrhosis cases.

Doctors say many people in the early, potentially reversible stages of NAFLD are unaware they have the disorder. Early diagnosis and intervention are important because studies suggest that 4 to 14 per cent of NAFLD patients advance to cirrhosis and 7 per cent of cirrhosis patients develop liver cancer.

“We’re hoping these guidelines will be used by physicians and other healthcare workers to identify people who are likely to have or are at high risk of NAFLD,” a health ministry official said. Up to 90 per cent of obese people and 80 per cent of those with diabetes have NAFLD.

The guidelines specify that there is currently no medication specifically approved for NAFLD treatment.