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Urbanization is happening at a rapid pace in India and it has brought with it drastic changes in the way people eat, move and live. These lifestyle changes are closely linked to increasing metabolic diseases such as diabetes, fatty liver disease and obesity. But the real source of the problem goes deeper – our biology.
Indians survived famine and hardship for millennia because they had to work hard in the fields. In order not to starve in those bad old days, our bodies evolved what scientists call the “thrifty genotype.” When this happened, the body became so good at saving and storing energy that the body began to burn fewer calories than it stored. Every calorie was put to good use, and whatever was left was stored as fat if society could not manage it in times of recession.
But today, that ancient survival mechanism is working against us. But the modern environment is virtually the exact opposite – food is everywhere, easy, cheap, highly processed and full of calories. Meanwhile physical activity has declined as a result of city living and sedentary jobs.
This combination of old genetics and new lifestyle is especially attractive among young Indians. These same genes that protected us at the time now provide our bodies with a way to store fat more efficiently, especially around the abdominal area and in the liver. Metabolic diseases are therefore emerging rapidly and increasing at unprecedented rates.
The thrifty phenotype: when early life nutrition predicts adult disease.
The “thrifty phenotype” adds to the genetic vulnerability, which refers to the adaptations made by the fetus during pregnancy, says Dr Rajeev Kovil, head of diabetology at He says many Indians are born with low birth weight due to maternal malnutrition for generations.
Small pancreatic beta-cell mass
· Low metabolic reserve
As adults, when faced with high-calorie diets, sugary beverages and sedentary lifestyles, their bodies cannot cope. The mismatch between a “conservative” metabolic setup and an “abundant” environment accelerates insulin resistance, visceral fat accumulation, and fatty liver and, often, at an earlier age.
Genetics of Fatty Liver: The PNPLA3 Connection
Research has identified some genetic variations that make Indians particularly susceptible to fatty liver disease. One of the most important, says Dr. Kovil, is the PNPLA3 (patatin-like phospholipase domain-containing protein 3) gene variant.
People with this variant are more likely to:
- Fat accumulates in the liver even without obesity
- developing fatty liver at an early age
- Rapid progression towards MASH (Metabolic Dysfunction-associated Steatohepatitis)
- have metabolic complications, including diabetes and heart disease
In simple words, some Indians may develop severe fatty liver even if they are not overweight.
Fatty liver is no longer a benign diagnosis. This is an early warning sign, a metabolic “red flag”.
- increased insulin resistance
- Prediabetes and progression to diabetes
- Higher risk of heart attack and stroke
- excess visceral fat
- Chronic inflammation and hormonal imbalance
In fact, fatty liver often predates diabetes by several years. By the time fasting glucose rises, the metabolic storm is already underway. India’s food ecosystem changed rapidly within just one generation. Our genes and physiology have not had time to adapt.
What happened instead?
- High-Carbohydrate Diet Culture: Our traditional plate is filled with rice, wheat, potatoes and sugars, which often have more than 70-80 percent carbohydrate content. In weakened individuals, it is quickly converted into triglycerides and accumulates in the liver.
- “Coca colonization”: The invasion of sugary drinks, fast food, packaged snacks, and ultra-processed calories has impacted metabolic health. Liquid sugar is converted into fat in the liver.
- Sedentary urban lifestyle: Modern work culture, long journeys, screen-based work and less physical activity are leading to weight gain.
- Rapid urbanization in one generation: What took 50-60 years in western countries happened in India in just 15-20 years. Our biological systems are still measured not for abundance, but for scarcity.
What should young Indians do?
The solution is early detection, prevention, reducing refined carbohydrates and saying no to sugary beverages, increasing muscle through strength training, prioritizing sleep and stress control, and getting regular liver and metabolic health checks.
Awareness, prevention and timely intervention can reverse this trend and save an entire generation from the burden of metabolic disease.
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