Fatty Liver

What is Fatty Liver?

Your liver plays a vital role in processing nutrients, and removing toxins from the body. However, when fat builds up in liver cells beyond a healthy level, it can affect these essential functions. This condition is known as fatty liver disease.

Fatty liver disease, medically known as hepatic steatosis, refers to the build-up of excess fat in the liver cells. While a small amount of fat in the liver is normal, excessive fat can interfere with liver function, and may progress to inflammation, scarring or even liver failure if left untreated. 

Unfortunately, this condition is increasingly common in Singapore due to modern sedentary lifestyles and dietary patterns.

Types of Fatty Liver Disease

There are several types of fatty liver diseases, including:

Non-Alcoholic Fatty Liver Disease (NAFLD)

NAFLD occurs in individuals who consume little or no alcohol. It is the most common form of liver disease worldwide, and closely linked to obesity, type 2 diabetes, and metabolic syndrome. NAFLD is categorised into 2 types, which are:

• Simple Fatty Liver (NAFL) – this early stage of NAFLD involves fat accumulation without liver inflammation or damage. Most people with NAFL do not experience symptoms, and the condition is often detected incidentally.

• Non-Alcoholic Steatohepatitis (NASH) – a more serious form of NAFLD, NASH is characterised by liver inflammation, and damage in addition to fat build-up. Over time, NASH can lead to fibrosis, cirrhosis, and an increased risk of liver cancer (link to liver cancer page).

Alcohol-Related Liver Disease (ALD)

ALD is a progressive condition that can begin as simple steatosis, and develop into alcoholic hepatitis or cirrhosis. It is commonly caused by chronic or excessive alcohol intake. Because of that, early diagnosis, and abstaining from alcohol are key to halting disease progression.

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

MASLD is a newly adopted term that encompasses fatty liver disease driven by metabolic risk factors. It includes conditions previously grouped under NAFLD, with a more precise focus on the metabolic origins of fat accumulation in the liver.

What causes Fatty Liver?

Fatty liver disease can arise from a mix of lifestyle, genetic, and metabolic factors. This includes:

• Certain medications – drugs such as corticosteroids, tamoxifen, and chemotherapy agents can cause liver fat to build up as a side effect.

• Excessive alcohol consumption – alcohol is toxic to liver cells, and its overuse promotes fat storage, inflammation, and liver damage.

• Genetic predisposition – some individuals may inherit a higher risk of developing fatty liver due to their genetic makeup, even with a healthy lifestyle.

• High cholesterol or triglyceride levels – raised levels of blood lipids can directly increase fat content in the liver, and contribute to inflammation.

• Obesity and visceral fat – excess body weight, especially fat stored around the abdomen, contributes significantly to fat accumulation in the liver.

• Poor dietary habits – diets high in processed food, sugar, and saturated fats can overwhelm the liver, leading to fat build-up over time.

• Rapid weight loss or malnutrition – sudden weight loss or insufficient nutrition can disrupt liver metabolism, and lead to fat accumulation.

• Type 2 diabetes and insulin resistance – insulin resistance causes glucose, and fat to build up in the bloodstream, encouraging fat storage in the liver.

How serious is Fatty Liver disease?

While many individuals with fatty liver remain asymptomatic, the condition can become serious over time. Progression from simple steatosis to inflammation, and eventually cirrhosis may occur, significantly impairing liver function. Some of the complications include:

• Decreased quality of life due to fatigue, abdominal discomfort, and systemic complications
• Hepatocellular carcinoma (liver cancer)
• Increased cardiovascular risk
• Liver fibrosis or cirrhosis
• Liver failure

What are the symptoms of Fatty Liver?

In its early stages, fatty liver is usually silent. However, symptoms may appear as the disease progresses, especially with inflammation or fibrosis:

• Abdominal bloating or fullness
• Dull pain or discomfort in the upper right abdomen
• Jaundice in advanced stages
• Loss of appetite
• Persistent fatigue or low energy
• Unexplained weight loss

Who is at risk of Fatty Liver Disease in Singapore?

Fatty liver disease can affect individuals across different age groups, but certain populations in Singapore are more prone to developing this condition. Some of the risk factors are:

• Age — fatty liver is more common among individuals who are 40 years old, and older. As people age, the risk of developing fatty liver increases, particularly due to age-related metabolic changes, and weight gain. 

• Alcohol consumption — while not everyone who drinks develops liver problems, regular heavy alcohol consumption significantly raises the risk of ALD, including fatty liver, and its complications.

• Family history – a genetic predisposition may make some individuals more vulnerable to fatty liver, even if they are not overweight or diabetic.

• Diabetes – insulin resistance is a key contributor to fatty liver disease. In Singapore, where diabetes is highly prevalent, those with poorly controlled blood sugar are at an increased risk of developing the disease.

• High cholesterol or metabolic syndrome – individuals with elevated blood lipids, high blood pressure, and other features of metabolic syndrome are more likely to develop liver fat accumulation, and inflammation.

• Obesity – those who carry excess weight, especially around the abdomen, have a significantly higher risk of fat accumulating in the liver. In fact, obesity is a major driver of NAFLD.

• Poor dietary habits – fatty liver is more common in individuals who consume a diet high in processed foods, sugary beverages, and saturated fats, particularly when combined with minimal exercise.

• Sedentary lifestyle – lack of physical activity contributes to weight gain, poor insulin sensitivity, and unhealthy fat distribution, all of which can lead to fatty liver.

How is Fatty Liver diagnosed?

Fatty liver is often diagnosed during routine health screenings or imaging performed for unrelated reasons. As early detection is crucial when it comes to treating fatty liver, it makes diagnosing the condition highly dependent on scheduled or impromptu medical evaluation.

• Blood test – liver function tests assess enzymes, and other markers that may indicate liver inflammation or injury. While enzyme levels may be normal in some individuals with fatty liver, abnormal results can suggest liver stress or progression to steatohepatitis.

• Liver biopsy – in cases where uncertainty arises or our doctors (link to about us page) suspect advanced diseases, such as cirrhosis, a biopsy may be performed to confirm the diagnosis, and assess inflammation or fibrosis.

• FibroScan (transient elastography) – FibroScan is a specialised, and non-invasive scan that measures liver stiffness, and fat levels. It helps assess whether there is fibrosis or more severe liver damage, without needing a biopsy. 

• Imaging scans – computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans may be recommended if more detailed imaging is needed. Both these scans can quantify liver fat content, and help distinguish fatty liver from other liver conditions or masses.

• Ultrasound – an ultrasound is typically used to detect increased fat content in the liver. During the procedure, fatty liver appears as a bright or echogenic liver on ultrasound due to fat accumulation.

How is Fatty Liver treated in Singapore?

The treatment route for fatty liver focuses on reversing fat accumulation in the liver, and preventing complications such as liver inflammation, scarring or cirrhosis. Even so, treatment is tailored based on the underlying cause, and the stage of liver involvement, which may include one or a combination of the following options:

• Medications — while there is currently no medication specifically approved for fatty liver in Singapore, some drugs used to treat diabetes or high cholesterol may offer liver-protective effects.

• Lifestyle modification — this is the cornerstone of treatment for most patients. Gradual, and sustained weight loss through a balanced diet, and regular exercise can significantly reduce liver fat and inflammation. In fact, even a 5 – 10% reduction in body weight can improve liver health.

• Diabetes and cholesterol control — optimising blood sugar, and lipid levels is crucial in managing fatty liver, especially in those with underlying metabolic conditions. This may involve medication, in addition to lifestyle changes.

• Limiting alcohol intake — for individuals with alcohol-related liver disease or those with coexisting fatty liver, reducing or eliminating alcohol consumption is essential to prevent further liver injury.

• Nutritional counselling — a liver-friendly diet is low in saturated fats, refined sugars, and processed foods. Our doctors can provide tailored plans to support metabolic health, and encourage sustainable habits.

• Monitoring and follow-up — regular follow-up with imaging, and blood tests helps track liver health, assess treatment progress, and detect complications early. Those with advanced fibrosis or cirrhosis, on the other hand, require specialist management.

Summary

Fatty liver disease is a common yet potentially serious condition. Fortunately, it is often reversible through lifestyle changes, and medical management, provided it is detected early. 

At Tan Siong San Surgery, we believe in holistic management and tailored care to help you protect your liver, and restore your overall health. If you are experiencing fatigue, abdominal discomfort or have risk factors for liver disease, book a consultation with us today for a detailed diagnosis and personalised treatment plan.