Fatty Liver

What is Fatty Liver?

The liver is the largest organ in the body and plays a pivotal role in supporting blood filtering, digestion, immunity, metabolism, detoxification, and more. The liver is also regarded as a gland as it produces bile, which helps the body turn fats into energy.

But as with any organ, the liver is at risk due to certain health conditions and lifestyle choices, such as fatty liver disease. Fatty liver, medically known as hepatic steatosis, is characterised by fat accumulation in the liver cells. The fat buildup can impede liver function and lead to health complications if left untreated.

There are two main types of fatty liver: alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD). AFLD occurs due to excessive alcohol consumption, while NAFLD is associated with factors such as obesity, insulin resistance, and metabolic syndrome.

Alcoholic Fatty Liver Disease (AFLD) Singapore

Alcoholic fatty liver disease (ALD) is described as a fatty liver disease that develops due to excessive alcohol consumption. One of the functions of the liver is to detoxify alcohol. Simply put, the liver breaks down the alcohol before it is flushed out of your body.

However, the process can generate harmful substances for the liver, damaging liver cells. Moreover, fatty liver effects also include inflammation and a weakened immune system. In fact, ALD is the initial stage of alcohol-related liver disease. If the treatment is delayed, the disease can progress to cirrhosis or alcoholic hepatitis.

Non-alcoholic Fatty Liver disease

NAFLD is a type of fatty liver disease that is not associated with alcohol consumption. There are two sub-types of NAFLD, these are:

• Simple fatty liver: a simple fatty liver disease indicates fat accumulation in the liver. However, there is little to no inflammation or damage to the liver cells, and a simple fatty liver usually does not lead to liver damage or complications.
• Nonalcoholic steatohepatitis (NASH): NASH indicates that there is fat, inflammation and liver cell damage in your liver. This is a call for concern as inflammation and liver cell damage can lead to fibrosis or scarring of the liver. In a worst-case scenario, NASH can potentially lead to liver cancer or cirrhosis.

What causes Fatty Liver?

The liver is responsible for breaking down fat and regulating cholesterol. The primary cause of fatty liver is an imbalance between the amount of fat entering the liver and the rate at which it is removed. A fatty liver can occur when the liver does not metabolise fat efficiently or if too much fat builds up. 

Fat build-up in the liver occurs due to the following:

• Consuming excess calories which causes fat to build up
• Malnutrition
• Rapid weight loss
• Obesity
• High blood lipid levels
• Alcohol abuse

What are the symptoms of Fatty Liver?

Both NAFLD and ALD do not show symptoms in their early stages. But as the disease progresses, the following are some symptoms that you might experience:

• Discomfort or pain in the upper right side of the belly
• Enlarged blood vessels
• Fatigue
• Jaundice
• Mental confusion
• Nausea or loss of appetite
• Red palms
• Swollen belly
• Unexplained weight loss

Who is at risk of Fatty Liver in Singapore?

The development of fatty liver disease, both alcoholic and non-alcoholic, can be influenced by various risk factors. Primary factors that increase the risk of developing fatty liver in Singapore include:

• Obesity: excess body weight, particularly visceral adiposity (fat around the abdomen), is strongly associated with non-alcoholic fatty liver disease (NAFLD). Obesity increases fat accumulation in the liver and contributes to insulin resistance.
• Insulin resistance and type 2 diabetes: Insulin resistance, a condition in which cells become less responsive to insulin, is a hallmark of metabolic disorders like type 2 diabetes. It promotes fat accumulation in the liver, contributing to the development and progression of NAFLD.
• High blood lipid levels: elevated levels of triglycerides and cholesterol in the blood, particularly when combined with insulin resistance, can increase the risk of developing NAFLD. 
• Metabolic syndrome: fatty liver disease is frequently found in individuals with metabolic syndrome, a cluster of conditions that includes obesity and high blood pressure. 
• Poor diet: an unhealthy diet high in refined carbohydrates, unhealthy fats, added sugars, and processed foods can contribute to the development of fatty liver disease. 
• Sedentary lifestyle: lack of physical activity and exercise is a significant risk factor for fatty liver disease. Regular exercise helps improve insulin sensitivity, promote weight loss, and reduce fat accumulation in the liver.
• Excessive alcohol consumption: chronic and excessive alcohol consumption is the primary cause of alcoholic fatty liver disease (AFLD). Heavy drinking can lead to fat accumulation, inflammation, and liver damage, eventually progressing to more severe liver conditions such as alcoholic hepatitis and cirrhosis.
• Genetics: genetic factors may predispose certain individuals to develop fatty liver disease. 
• Medications and toxins: certain medications, including corticosteroids, tamoxifen, methotrexate, and antiretroviral drugs used to treat HIV/AIDS, may increase the risk of developing fatty liver disease. Exposure to environmental toxins and industrial chemicals can also contribute to liver damage and inflammation.
• Other medical conditions: certain medical conditions, such as polycystic ovary syndrome (PCOS), hypothyroidism, and obstructive sleep apnoea, are associated with an increased risk of fatty liver disease. 

How is Fatty Liver diagnosed in Singapore?

A combination of diagnostic procedures will be utilised to confirm fatty liver disease. Fatty liver diagnosis in Singapore may include:

• Medical history: your gastro specialist will discuss your medical history, past treatments, and medications. These contribute to the development of fatty liver.  
• Physical examinations: a physical exam involves palpation of the abdomen to check for signs of an enlarged or tender liver.
• Blood tests: a series of blood tests may be conducted. These tests include a liver function test, complete blood count, and metabolic markers test. 
• Imaging tests: computerised tomography (CT) scans and magnetic resonance imaging (MRI) will help doctors see if any fat is present in your liver and determine if you have simple fatty liver disease or NASH. From there, your doctor may order additional tests to determine your liver's stiffness, such as transient elastography or magnetic resonance elastography (MRE).
• Liver biopsy: a liver biopsy may be recommended if you have NASH to analyse the extent of damage or inflammation in the liver.

What are the treatment options for Fatty Liver?

The early stages of liver disease, such as fatty liver and liver fibrosis, are treatable and reversible. If left untreated, fatty liver can progress to irreversible liver cirrhosis and liver cancer. Treatment for fatty liver in Singapore typically includes:

• Lifestyle changes: weight loss, healthy diets, exercise, and reduced alcohol consumption can positively contribute to reversing fatty liver, promoting liver health, and preventing the disease from progressing.
• Medication: medication such as insulin sensitisers, anti-oxidants, and lipid-lowering drugs may be prescribed to treat conditions that cause fatty liver, thus improving liver health.
• Monitoring and follow-up: regular monitoring of liver function tests, imaging studies, and metabolic parameters is essential for assessing disease progression and treatment response. Your healthcare provider may recommend periodic blood tests, ultrasound scans, or other imaging modalities to monitor liver health.
• Liver transplant: in rare cases of advanced liver disease or liver failure that cannot be managed with conservative treatments, liver transplantation may be considered as a last resort.

Frequently asked questions

How do you fix a fatty liver?

Fixing or reversing a fatty liver involves implementing lifestyle changes that reduce liver fat accumulation, improve liver function, and prevent the progression of the disease. 

Can fatty liver be cured?

Fatty liver disease, particularly in its early stages, can often be effectively managed and reversed with lifestyle changes and appropriate medical interventions. However, whether the condition can be completely cured may depend on various factors, including the underlying cause of the fatty liver, the extent of liver damage, and your response to treatment.

What is the life expectancy of fatty liver disease?

Assuming that your fatty liver disease is reversible, you would have a positive outlook. However, the life expectancy for patients with NASH or cirrhosis is between 10 to 15 years, provided it is detected early.

Do I have to quit drinking alcohol as a precautionary measure?

It depends on your condition. If your liver is severely damaged or has extensive scarring, then your doctor may encourage you to quit alcohol. However, reducing your intake is usually sufficient.