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Fatty Liver Disease

Gastroenterology Hepatology

Fatty Liver Disease, formerly known as Steatohepatitis, is a condition in which the liver accumulates fat in excess of 5% of its own mass. Fatty liver disease is an increasingly common urban disease in Hong Kong, with one in four people suffering from fatty liver disease[1]. Fatty liver disease can be classified into two main categories: alcoholic fatty liver disease and non-alcoholic fatty liver disease. A local university study estimated that there are over 100,000 new cases of NAFLD in Hong Kong each year, which is a cause for concern.[2]

Symptoms

Fatty Liver Disease has no visible symptoms after the onset of the disease and it is difficult to realise that your body has turned on the red light. This silent warning sign means that a person may have fatty liver for 10 to 15 years without realising it.

However, when the disease worsens and the liver becomes more inflamed, some patients may experience the following symptoms:

Fatigue
Weakness
Jaundice
edema
unexplained weight loss
Right upper abdominal tenderness

Long-term health effects of Fatty Liver Disease:

As fatty liver does not show any obvious symptoms, if it worsens, it can lead to chronic inflammation of the liver. This chronic inflammation damages the liver and weakens liver function. In the early stages of the disease, fatty liver can be reversed. However, if the warning signs are not dealt with, the chronic inflammation will continue to damage liver function and cause liver fibrosis, which in severe cases can lead to cirrhosis, liver failure and even liver cancer.

In addition, Non-alcoholic fatty liver disease (NAFLD) increases the risk of other diseases, especially cardiovascular diseases (e.g. heart disease, stroke), diabetes, hypertension, high cholesterol and metabolic syndrome.

Causes and Risk Factors

Fatty liver can be caused by a variety of factors, usually categorized as alcoholic fatty liver due to excessive alcohol intake and non-alcoholic fatty liver due to other factors. These factors include nutritional imbalance, insulin resistance, diabetes, pregnancy, and medication side effects. Although there is still no consensus in the medical community on the causes of fatty liver, risk factors have been identified.

Alcohol is a risk factor for developing alcoholic fatty liver disease, while the following people are at high risk for developing non-alcoholic fatty liver disease:

Over 50 years of age
Have high blood pressure, high blood glucose, and high cholesterol (the "3 H's")
Have metabolic syndrome
Have smoking habit
Obese / overweight

Lifestyle habits are closely related to fatty liver. Alcohol, smoking and obesity are all controllable risk factors, and those who are concerned about fatty liver should adopt healthy lifestyle habits.

Diagnosis

Review the patient's symptoms, lifestyle and medical history, and perform a palpation test.
Generally, liver function is checked by blood test first, followed by imaging or other tests (e.g. ultrasound, electron scan, magnetic resonance imaging) depending on the patient's condition.
Common imaging tests (ultrasound) can detect fatty liver but cannot detect the percentage of liver fat and liver damage after inflammation.
Depending on the patient's condition, some patients may need to have liver tissue extracted for diagnosis.

	Advantages	Disadvantages
Ultrasound/Electronic Scanning/Magnetic Resonance Imaging (MRI)	pervasive non-invasive	Failure to detect the percentage of liver fat, liver damage after inflammation Radiation from electronic scans
Liver fibrosis scan (FibroScan®)	Non-invasive Detects liver fat percentage and post-inflammatory liver damage	Higher fees
Liver Biopsy	Detects the percentage of liver fat Accurately diagnose liver inflammation	Invasive Risk of complications such as infection

Treatment

There is no specific drug or surgical treatment for fatty liver. Certain vitamins or supplements may reduce liver damage in an inflamed state, but they cannot cure the liver. The human liver has a very strong ability to repair itself and fatty liver in the early to mid-stage can still be reversed and the patient can start to improve his or her lifestyle.

For patients with alcoholic fatty liver disease:

Alcohol cessation

For non-alcoholic fatty liver patients:

Change dietary habits and reduce excessive sugar intake.
Regular exercise to improve metabolism
Proper weight management
Reduce alcohol intake

Preventive screening

Prevention of fatty liver is more important than treatment. Fatty liver is more likely to occur in centrally obese people, but the two are related but not the same, as people of average or even thin stature may have an insidious case of fatty liver.

Fatty liver is a disease with hidden symptoms. Therefore, it is through liver screening that we can detect the disease and take preventive measures.

The following people who are at higher risk of developing NAFLD are recommended to have their liver fat levels checked regularly for early follow-up:

Aged over 50
Have high blood pressure, high blood sugar and high cholesterol (the "3 H's").
Suffer from metabolic syndrome
Have insulin resistance
Obesity/heavy weight, increased waist size

The most effective way to prevent fatty liver disease is to avoid the above risk factors through lifestyle. A balanced diet should be maintained, with adequate intake of nutrients, while avoiding excessive intake of foods with refined sugar or refined starch. At the same time, it is recommended to cultivate the habit of exercising to enhance the metabolic rate and promote the body's fat elimination mechanism, so as to reduce the accumulation of fat in the body, including the liver.

FAQ

No. One in five non-obese people has NAFLD.

There is no evidence to suggest that night work is related to fatty liver disease, but excessive consumption of refined sugary foods (e.g. crisps, soft drinks, ice-cream) as a late-night snack may increase the risk of developing fatty liver disease!

If fatty liver is detected at an early stage, you can seek help from your doctor, dietitian or physiotherapist to formulate a suitable treatment plan to improve the condition of fatty liver. Once the condition is under control, regular check-ups and monitoring are also important.