Dr Kieron Lim
Consultant Gastroenterologist & Hepatologist
MBBS, University of London, Member, Royal College of Physicians (UK), Fellow, Academy of Medicine (Gastroenterology) Singapore, Fellow, Royal College of Physicians (Edinburgh)
What Is Fatty Liver (Hepatic Steatosis)?
Fatty liver disease, also known as hepatic steatosis, is a condition characterised by the accumulation of fat in the liver cells.
In some cases, it could be due to excessive alcohol consumption, leading to alcoholic fatty liver disease. Non-alcoholic causes such as obesity, insulin resistance, high blood sugar, and certain medications can contribute to fatty liver disease.
Fatty liver disease can range from mild to severe. This may progress to more serious conditions, such as
non-alcoholic steatohepatitis (NASH), liver fibrosis, cirrhosis, and liver cancer, if left untreated.
In Singapore, fatty liver disease affects around 40% of the population and often progresses without noticeable
symptoms. As a result, many people remain unaware they have the condition.
What Is Non-Alcoholic Fatty Liver Disease (NAFLD)?
Non-Alcoholic Fatty Liver Disease (NAFLD) is a subtype of fatty liver disease that affects individuals who consume little to no alcohol. This condition often affects overweight or obese patients, leading to more severe liver diseases such as non-alcoholic steatohepatitis (NASH), which involves inflammation, liver cell damage, and liver cirrhosis. NAFLD is typically a silent disease with few or no symptoms, but it is closely linked to certain health conditions and diseases, including obesity.
What are the 4 Stages of NAFLD?
Non-Alcoholic Fatty Liver Disease (NAFLD) evolves through four main stages, each associated with specific changes in the liver's structure and function.
Simple Fatty Liver (Steatosis)
This stage represents the initial phase of NAFLD, marked by the accumulation of excess fat in liver cells. Typically, there is no inflammation or damage to the liver cells, and it often remains asymptomatic without complications.
Non-Alcoholic Steatohepatitis (NASH)
If NAFLD progresses, it can lead to non- alcoholic steatohepatitis (NASH), a more serious form of the disease. NASH is characterised by inflammation of the liver, which can damage the liver cells and potentially lead to scarring (fibrosis).
Liver Fibrosis
At this stage, ongoing inflammation causes scar tissue to form in the liver, replacing healthy liver tissue. This process of scarring is called fibrosis. While the liver can still function at this stage, its ability to regenerate and perform vital roles becomes increasingly impaired.
Liver Cirrhosis
This is the most severe stage of NAFLD. Cirrhosis occurs when the liver is extensively scarred, leading to a significant loss of liver function. It can result in serious complications, including liver failure and liver cancer.
What are the Causes and Risk Factors of NAFLD?
Fatty liver disease can arise from a combination of lifestyle habits, metabolic conditions, and underlying health issues. Over an extended span of time, these factors may lead to an inability for the liver to effectively process and break down excess nutrients.
Key risk factors for fatty liver include:
Obesity
Being overweight or obese (with a body mass index above 25) significantly increases the likelihood of developing fatty liver disease. Excess body fat, especially around the abdomen, is closely linked to metabolic dysfunction and insulin resistance, both of which promote fat storage in the liver.
Diabetes
Individuals with type 2 diabetes are more prone to fatty liver disease due to insulin resistance, a condition where the body does not respond effectively to insulin. This leads to higher levels of glucose and fatty acids in the bloodstream, which are then deposited in the liver. Over time, this can worsen liver inflammation and increase the risk of more advanced liver conditions.
High Blood Sugar
Persistently elevated blood sugar levels, even in individuals without diagnosed diabetes, can contribute to fat accumulation in the liver. Excess glucose is converted into fat through a process known as de novo lipogenesis, leading to increased fat storage within liver cells and further impairing metabolic health.
Elevated Levels of Fats in the Blood
High levels of cholesterol and triglycerides in the bloodstream can promote fat buildup in the liver. These circulating fats are taken up by liver cells and stored, especially when the body’s ability to process and export fat is overwhelmed.
High Blood Pressure
Hypertension may contribute to vascular changes and inflammation that affect liver health over time.
Autoimmune or Inherited Liver Diseases
Certain genetic disorders and autoimmune diseases can predispose individuals to fatty liver disease
What are the Warning Signs of NAFLD?
Non-Alcoholic Fatty Liver Disease (NAFLD) often presents no symptoms in its early stages. However, as the disease progresses, several warning signs may initially emerge:
Fatigue
Fatigue is a common symptom of many liver diseases, including NAFLD. Patients may feel constantly tired or weak.
High Blood Pressure
While high blood pressure is also a risk factor for NAFLD, it can also occur due to the disease. This is because NAFLD can contribute to the development of cardiovascular diseases.
Upper Abdominal Discomfort
Some people with NAFLD may experience discomfort or pain in the upper right of the abdomen, where the liver is located.
What are the Symptoms of Advanced NAFLD?
In the advanced stages of Non-Alcoholic Fatty Liver Disease (NAFLD), more severe symptoms may develop, such as:
Jaundice
Jaundice is characterised by a yellowing of the skin and eyes. This occurs when the damaged liver cannot properly process bilirubin, a by-product of red blood cell breakdown.
Abdominal Distension From Fluid Retention
Also known as ascites, this symptom arises when the liver cannot produce enough protein to hold fluid in the bloodstream, causing fluid to accumulate in the abdomen.
Internal Bleeding From Swollen Blood Vessels (Varices)
In response to liver damage, blood may flow into smaller vessels that cannot handle the increased volume. This can cause the vessels, particularly those in the oesophagus and stomach, to swell and potentially bleed.
Confusion
Hepatic encephalopathy occurs when the liver cannot remove toxins from the blood, causing them to build up in the brain. This leads to confusion and other cognitive problems.
Coma
In severe cases of hepatic encephalopathy, the patient may fall into a coma due to the high levels of toxins in the brain.
Liver Failure
This is the most severe stage of liver disease. When the liver fails, it stops performing its essential functions, which can lead to a multitude of life-threatening complications.
When to See a Doctor for Non- Alcoholic Fatty Liver Disease
If you experience persistent fatigue, discomfort in the upper right abdomen, or any advanced symptoms like jaundice or abdominal distension, seek medical attention promptly.
Additionally, if you have risk factors such as obesity, diabetes, or high cholesterol, regular screenings can help detect NAFLD early.
Early intervention is key to managing NAFLD and preventing progression to more serious liver conditions. A fatty liver specialist in Singapore can assess your overall health and develop a personalised treatment plan, which may include lifestyle changes, dietary guidance and medication where appropriate to support liver health and prevent further damage.
How Is Non-Alcoholic Fatty Liver Disease (NAFLD) Diagnosed?
The diagnosis of NAFLD often involves a combination of blood tests, imaging procedures, and, in some cases, a liver biopsy. These methods help liver specialists to determine the extent of liver damage and rule out other potential causes of liver disease.
Blood Tests
Blood tests can reveal liver function abnormalities and help identify other conditions that may cause similar symptoms. Elevated liver enzymes may suggest liver damage, particularly alanine aminotransferase (ALT) and aspartate aminotransferase (AST).
Imaging Procedures
Imaging tests such as ultrasound for fatty liver, CT scan, or MRI can show fat accumulation in the liver. These non- invasive procedures are often the first step in diagnosing NAFLD.
Liver Biopsy
A liver biopsy involves inserting a needle into the liver to collect a small tissue sample for examination under a microscope. A biopsy can confirm a diagnosis of NAFLD and show the degree of liver damage or inflammation.
FibroScan
FibroScan is a method used to diagnose NAFLD. It utilizes transient elastography to quantify the fat content in the liver and measure liver stiffness, which has been proven to correlate with liver fibrosis or scarring. It is a quick, non-invasive and painless test with high accuracy. There is also no need for any anaesthetic, no risk of bleeding and zero downtime.
What are the Treatment Options for NAFLD?
Weight Loss
In overweight or obese individuals, losing weight can reduce fat in the liver. This may be achieved through a balanced diet and regular exercise.
Lifestyle/Dietary Modifications
Maintaining a healthy diet rich in fruits, vegetables, whole grains, and healthy fats helps manage NAFLD. It is also advisable to avoid high-calorie meals and saturated fat. Limiting alcohol consumption is also advised.
Medication and Supplements
There is no specific drug approved solely for the treatment of NAFLD, but certain medications may help manage underlying issues such as insulin resistance, high cholesterol or diabetes, which contribute to liver fat accumulation. Some supplements, like vitamin E, may help reduce liver fat and inflammation. However, it is essential to consult a doctor before starting any medication or supplement to ensure they are appropriate for individual health needs.
Bariatric Surgery to Achieve Weight Loss
In severe cases, bariatric surgery may be considered as a form of fatty liver treatment. For eligible patients, this procedure can help achieve substantial weight loss and improve liver health in people with NAFLD. However, it carries risks and should only be considered when other options have been exhausted—and under the guidance of a fatty liver specialist or qualified healthcare provider.
Helpful Links
Frequently Asked Questions (FAQs) About Fatty Liver Disease
What is the difference between Alcoholic Fatty Liver Disease (ALD) and Non-Alcoholic Fatty Liver Disease (NAFLD)?
What happens if fatty liver remains undiagnosed and untreated?
Can Non-Alcoholic Fatty Liver Disease (NAFLD) be reversed?
What foods should you avoid if you have a fatty liver?
Can NAFLD be prevented?
Meet Our Fatty Liver Specialist
Dr Kieron Lim
MBBS, University of LondonMember, Royal College of Physicians (UK)Fellow, Academy of Medicine (Gastroenterology) SingaporeFellow, Royal College of Physicians (Edinburgh)
With over two decades of specialist experience, Dr Kieron Lim is a Senior Consultant Gastroenterologist known for treating diverse gastrointestinal, liver, and pancreatic conditions. As the former Head of the Division of Gastroenterology and Hepatology at the National University Hospital, he is recognised for his patient outcomes and service quality. He also mentors medical professionals in complex hepatology cases and has contributed actively to the research and advancement of the field.
Location
Mount Elizabeth Medical Centre
3 Mount Elizabeth #10-02Singapore 228510
Contact Us
Whatsapp: (65) 9726 0495 | Telephone: (65) 6836 0080
Fax: (65) 6836 0090 | Emergency: (65) 6533 0088
Email: enquiries@kieronlimgastro.sg