Pooling data from 11 Indian studies covering 3,512 children and adolescents under 18, this meta-analysis estimates an overall NAFLD prevalence of 35.4% (95% CI: 19.7%–52.9%). In the general-population subgroup, prevalence drops to 10.7%, but among high-risk overweight or obese youth it surges to 59.7% (95% CI: 55.2%–64.1%) — meaning nearly 3 in 5 obese Indian children may already carry fatty liver disease. Heterogeneity was extreme in the overall and general-population pools (I² = 99% and 96.6%, respectively), reflecting wide methodological variation across source studies.
These numbers demand context. Globally, paediatric NAFLD prevalence is estimated at roughly 7–10% in general populations, making India's 10.7% community figure already elevated — likely driven by dietary transition toward ultra-processed foods, rising childhood obesity, and genetic predisposition including the PNPLA3 I148M variant prevalent in South Asian populations. The 60% figure in obese children rivals estimates from Middle Eastern cohorts and underscores how metabolic risk compounds hepatic injury early in life. NAFLD in childhood tracks strongly to adult cirrhosis, type 2 diabetes, and cardiovascular disease, making early identification a genuine longevity issue, not merely a paediatric one.
Critical limitations apply: only 11 studies qualified, extreme heterogeneity weakens the pooled estimate's precision, and diagnostic methods varied across studies. As a preprint not yet peer-reviewed, these figures could shift materially after scrutiny. Still, even conservative readings point to an underappreciated paediatric metabolic crisis requiring urgent screening protocols in Indian clinical practice.