Needless to say, it is important to care for the liver’s wellbeing and to be aware of various liver diseases. One of them is fatty liver disease, which, unfortunately, is increasingly common these days.

FMT spoke to Dr Shanthi Palaniappan, a consultant gastroenterologist and physician based in Kuala Lumpur, for her insights on this disease, specifically a category called “non-alcoholic fatty liver disease”.

What is fatty liver disease?

Fatty liver disease happens when there is too much fat build up in liver cells. There are two main categories:

• Alcohol-related fatty liver disease
• Non-alcoholic fatty liver disease

“In the first case, someone who consumes excessive amounts of alcohol over a long period of time can suffer from liver damage. But this actually starts off from fat build up in the liver,” she told FMT.

This will eventually lead to inflammation in the liver cells. Prolonged inflammation will lead to scarring, a condition called “fibrosis”. Should the inflammation persist, it can lead to further scarring, or a condition called “cirrhosis”. This can then affect the function of the liver.

Non-alcoholic fatty liver disease

However, even those who do not consume alcohol can have fatty liver disease. “Non-alcoholic fatty liver disease (NAFLD) is a condition where fat accumulates in the liver cells but is not associated with the consumption of alcohol, medication, or viruses such as hepatitis C.

“We know that there is association between NAFLD and factors such as being overweight or obese; having high blood pressure and cholesterol; or suffering from diabetes or prediabetes.”

These factors are also known as metabolic syndromes which happen when there is insulin-resistance. This is when liver cells do not respond well to the insulin produced by the pancreas and can’t take up glucose from the blood readily. Because of this association, a new term “metabolic-associated fatty liver disease” has been introduced.

However, she added that there are also a small percentage of people with no metabolic syndrome (i.e: not overweight with normal levels of sugar, cholesterol, and blood pressure) who still end up with NAFLD.

There are two types of NAFLD:

• Non-alcoholic fatty liver (NAFL): generally, a benign condition in which there is fat infiltration but no inflammation.
• Non-alcoholic steatohepatitis (NASH): fat infiltration exists along with liver inflammation. This can lead to “cirrhosis” and ultimately liver decompensation (when the normal function of the liver is not carried out) as well as liver cancer.

How common is it?

According to Shanthi, two studies reported that the overall prevalence of NAFLD in Malaysia is between 20% to 40%.

“This is high, and the statistics doesn’t include children who are getting heavier due to a more sedentary lifestyle and increased consumption of fast or processed food,” she said.

Symptoms

Unfortunately, because the disease is initially asymptomatic, most people don’t know they have it. “Symptoms only develop when the liver is damaged and by this time, it is already too late,” she cautioned.

Therefore, early diagnosis is key. So, getting a blood test or ultrasound as part of an annual medical check-up is highly recommended.

Once someone has been diagnosed with the disease, they can test if “fibrosis” has happened in the following ways:

• Blood test
• Fibroscan (elastography test)
• Liver biopsy

Treatment

“Unfortunately, despite it being a common disease, there is no single drug that has been specifically approved to treat NAFLD by regulatory bodies such as the US Food and Drug Administration,” she shared, adding that of the drugs that were used, none showed consistent benefits.

“However, for a patient who suffers from high cholesterol, diabetes and/or are overweight, we will focus on treating those conditions and getting them to lose weight as well as adopt a healthier lifestyle as we want to target the cause behind the disease.”

Can it be reversed?

Shanthi shared that during the initial stages, a reversal of fatty liver is possible through a healthy diet, regular exercise, and weight loss. “However, once “cirrhosis” happens, it can be difficult to reverse the scarring.”

Prevention

“Diet is what makes or breaks you, so ensure that it consists of a healthy serving of vegetables, fruits, and grains,” she said, recommending a Mediterranean-based diet high in fibre, seafood, and olive oil.

However, reducing simple carbohydrates (those that can be broken down quickly by the body to be used as energy) can also help. That’s because when a person consumes too much carbohydrates, it will be converted to fat and stored in the body,” she shared, adding that regular exercise is therefore important.

Additionally, several studies have also shown that intermittent fasting can be beneficial. “By reducing your calorie intake, it helps in not taxing your pancreas too much.

“It is advisable to go for medical check-ups at least once a year. This will help you to find out whether you have the disease. If you do, the doctors can advise on further steps that you can take.”