Fighting the fatty liver pandemic: Developing effective protocols & local expertise to deliver & evaluate interventions for better liver & metabolic health in India (FFL)

1st November 2018 - ongoing

Status: Active

Specialism: Liver.

Team: Professor Guruprasad AithalDr Jane GroveDr KT ShenoyDr KB LeenaDr Ana ValdesProfessor Penny Gowland.


Prof Guru Aithal, Dr KT Shenoy, Dr Leena, Prof Sally Hibbert, Prof Andy Salter, Dr Ana Valdes, Dr Jane Grove, Dr Stephen Bawden, Dr Liz Simpson, Dr Moira Taylor, Ms Laura Miller, Prof Penny Gowland, Prof Ian Macdonald


Dr Amrita Vijay, Dr Stuart Astbury, Ms Beth Robinson, Ms Melanie Lingaya, Dr Jane Chalmers

Study Statistician:

Dr Lu Ban


NIHR Nottingham Biomedical Research Centre, University of Nottingham & Nottingham University Hospitals Trust, Nottingham, UK,

Population Health and Research Institute (PHRI), Trivandrum, India

Holistic Health Research Institute (HHRI), Trivandrum, India


Our goal is to improve the health of individuals and reduce non-alcoholic fatty liver disease (NAFLD) and concurrent metabolic syndrome in the south Indian region of Kerala. 

Fighting Fatty Liver: 

A ‘Fatty liver’ is when more than 5-10% of a person’s liver is fat. This condition puts people at much higher risk of developing diabetes and heart disease;  if left untreated, it can be a ‘silent killer’. This fat deposition in the liver can lead to inflammation and liver damage and progress to scarring, seriously affecting liver function and eventually leading to the need for a liver transplant. We understand only in part how NAFLD develops and progresses. There are currently no licenced medications to treat it. However, fatty liver disease can be reversed if changes in a person’s diet and exercise level are made before damage becomes irreversible. 

We therefore want to identify ways to reduce NAFLD so we need to understand the steps involved in it developing and importantly the role of diet in its prevention and treatment.  

Why study people in India?  

In the UK, fatty liver is twice as common among people of South Asian descent compared with whites: 2 in 10 versus 1 in 10. In some parts of India (e.g. Kerala) the prevalence is 5 in 10. We believe that this higher risk is in part caused by dietary and lifestyle factors. In particular, white rice consumption (which elevates blood sugar & insulin levels after eating) is high and may promote fat deposition in the liver. Another cause may be differences in the microbes in the gut which affect how fat is processed by the liver. Some gut microbes convert dietary fibre into short-chain fatty acids which may protect people from getting diabetes and fatty liver. We aim to show that giving a diet high in fibre (with more protein and lower ‘Glycaemic index’) can improve liver health.  


We propose a dietary intervention (involving 84 NAFLD patients), based on our knowledge of dietary habits in Kerala (from questionnaires of 2000 with/without NAFLD), in collaboration with a research team in Kerala. Participants will replace the white rice they usually eat with red rice and lentils for 16 weeks. We have developed this diet based on previous studies showing how to reduce NAFLD and via discussion with Indian NAFLD patients.  

The project will also include training Indian healthcare professionals in how to develop, implement and evaluate dietary/lifestyle interventions. This means further interventions can be designed and delivered effectively in Kerala to sustain long term improvements in population health. Our results will also help us design diets for other parts of the world that are facing similar health problems. The resources can thus be reused, with tailoring to suit local conditions, in other countries.  

Determining effect of diet:  

Before and at the end of the dietary intervention, participants will have MRI scans and provide blood, urine and faecal samples. Liver health & fat content, and insulin functioning will be assessed. Faecal will be also determined to discover the effects of dietary change.    

Scientific value:  

The results from this investigation will help us to identify the processes and chemicals involved in the development of fatty liver and will be valuable in the development of new dietary treatments and new drugs. It will enable us identify effective strategies and hence design the best dietary interventions to reduce fatty liver and diabetes in both South Asians (in India & UK) and other populations (globally).  

Impact in the community:  

This work will expand an ongoing collaboration with PHRI in India, and will extend expertise, capability and capacity via training of their research and healthcare staff. “Participant and Public Involvement” training and development of an informed and involved Patient Advisory Group will promote diet & health awareness and enable future randomised controlled trials in Kerala.  

This will facilitate our goal to reduce the burden of fatty liver disease in Kerala.

Fighting Fatty Liver in Trivandrum news article

Photo Name Bio
guruprasad-aithal Professor Guruprasad Aithal Biography Professor Guruprasad P. Aithal graduated with MBBS from Kasturba Medical College, Manipal, MD (Internal Medicine) from Bangalore Medical College, Bengaluru, India and completed his specialist training in Gastroenterology in the Northern…
dr-jane-grove Dr Jane Grove I am an Assistant Professor in the Hepatology Group in the NIHR Nottingham Biomedical Research Centre and the MRC-funded Nottingham Molecular Pathology Node ( My research includes translational research projects in the following…
Dr KT Shenoy Track Record in delivering research for the benefit of local economies and society: Implemented the Computerization of the Medical College and Hospital in Trivandrum in 2003-2004. Implemented the Telemedicine Unit for the Health Department in…
Dr KB Leena Dr K B Leena has a doctoral Degree in Biochemistry from University of Kerala in 1997 and is an integral part of the Population health and Research Institute, Trivandrum. She is a co-investigator in many population based research initiatives such as a…
Dr Ana Valdes Ana M. Valdes received her M.A. and Ph.D. from the University of California at Berkeley, USA, where she specialized in Genetic Epidemiology. She is a Reader and Associate professor at the University of Nottingham. Her research is focused on deciphering…
professor-penny-gowland Professor Penny Gowland Developing quantitative MRI for biomedical applications. I am particularly interested in exploiting the capabilities of functional and anatomical ultra-high field MRI in neuroscience, in using the increased contrast to noise ratio available at ultrahigh…
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