Fatty Liver: Causes and How to Reverse It

A recent study conducted by Duke-NUS Medical School and Singapore General Hospital (SGH) showed that up to 40 per cent of Singaporean adults (compared to 27 per cent globally) have fatty liver disease.

Onc​e considered a middle-aged disease associated with excessive alcohol drinking, fatty liver disease (or steatotic liver disease), now affects more young people who drink little or no alcohol.

“The incidence of fatty liver in Singapore is increasing just like in most parts of the developed world. Many of the relatively young people whom I t​reat for gallstone disease also have fatty liver,” shares Professor Pierce Chow, Senior Consultant from the Division of Surgical Oncology at National Cancer Centre Singapore (SGH), a member of the SingHealth group.

The good news is a simple fatty liver condition is reversible in most cases.

However, if it is not managed properly, a fatty liver can lead to a more serious liver disease called non-alcoholic steatohepatitis (NASH) where the fatty liver becomes inflamed.

This can cause liver cirrhosis (liver scarring) and liver cancer.

• Avoid obesity!
  As Asians have a higher risk of health problems at a lower BMI compared to Caucasians, strive to achieve a healthy BMI of between 18.5 to 22.9 kg/m². 
  
  A BMI ranging from 23.0 to 27.4 kg/m² puts you at moderate risk for health problems, while a BMI at 27.5 kg/m² and above puts you at high risk. Also, the ideal waist circumference cut-off for Asian men is 90cm, while for Asian women it is 80cm.

  If you are overweight, losing between 5 per cent to 10 per cent can help to shed the fat in the liver.  

• Adopt a well-balanced diet

  The (HPB) My Healthy Plate is a good guide to follow. Eat a quarter plate of complex carbs like oats and brown rice. Avoid refined carbohydrates. Also, eat half a plate of all kinds of vegetables. Lastly, fill the last quarter of your plate with plant-based or low-fat protein such as beans and nuts, or eat lean meat, poultry fish and low-fat dairy products.

  You can also try to switch to a Mediterranean diet, which emphasises the consumption of whole grains, lean proteins (more fish, less red meat), healthy fats and non-starchy vegetables.
  
  Eliminate refined sugar from your diet completely! Drink 8 to 12 cups of water daily.

• Exercise more! 
  Exercise at least five times a week. Each session should last at least 30 to 60 minutes. It can be any form of exercise but it should at least raise the pulse rate moderately.
  
  Exercises you can do include brisk walking (a walking pace of 1km in 10 to 15mins), badminton, cycling, swimming and table tennis.
  Exercise more! 
  
  
• If you have chronic conditions such as diabetes (type 2 diabetes mellitus), high cholesterol and high blood pressure (hypertension), ensure that they are well-controlled.
  
  
• Reduce alcohol consumption, or even better, avoid it entirely.
  
  
• Avoid unnecessary use of medications that may affect liver health.
  
  
• Have regular health check-ups to monitor liver function and overall metabolic health.

A fatty liver is an abnormal accumulation of fats in the liver cells.

Non-alcoholic fatty liver disease (NAFLD) is closely linked to obesity, diabetes and the metabolic syndrome, conditions which are also on the rise. 

Studies have shown that up to 80 per cent of obese people and 70 per cent of people with diabetes have fatty liver disease.

High cholesterol and high blood pressure are also correlated with fatty liver although fatty liver can be found among the young and thin with no high blood pressure.

Common causes include:

• Diabetes
• Obesity (having a BMI>25kg/m² for Asians)
• Increased belly fat (central obesity), where the waistline >90cm for Asian men or >80cm for Asian women
• High cholesterol (hyperlipidaemia)
• High blood pressure (hypertension)
• Metabolic syndrome
• Other associated conditions like obstructive sleep apnea (OSA), Polycystic Ovary Syndrome (PCOS), Underactive Thyroid (Hypothyroidism), Underactive Pituitary (Hypopituitary) 

Fatty liver disease is diagnosed by a combination of history, physical examination, blood tests and imaging studies of the liver such as:

• Liver function tests such as liver enzymes (ALT, AST) may be elevated

• Ultrasound, CT or MRI scan may show fatty liver

• Other blood tests may be needed to predict severity of disease or exclude other liver diseases

• Liver biopsy may be required to stage the disease

Treatment for fatty liver includes:

• Lifestyle modifications

• Control of diabetes, high blood pressure (hypertension), obesity, high cholesterol (hyperlipidaemia)

• Medications

Management involves diagnosing and treating the underlying cause of the fatty liver disease.

“With counseling, a few of my patients became very motivated and managed to reverse their fatty liver disease through disciplined lifestyle changes,” says Prof Chow.

It is important that young people with fatty liver take steps to control their weight and glucose levels to prevent the condition from deteriorating, adds Prof Chow.

1. What foods should be avoided to prevent fatty liver disease?

Limit consumption of processed foods, added sugars, refined carbohydrates, saturated fats and excessive alcohol. Foods high in trans fats and sugary drinks should also be avoided, as they contribute to fat accumulation in the liver.

2. Why is a healthy liver important?

The liver, located in the right upper abdomen, is a key organ. It keeps the body in optimal health by performing metabolic and detoxifying functions.

A healthy liver regulates the amount of fat, protein and glucose in the blood. It processes nutrients from the intestines. It also removes toxins and drugs from the bloodstream.

Ref: T12

Check out other liver condition articles:

Liver Cancer: Risk Factors, Symptoms and Treatment

Liver Cancer: 5 Ways to Reduce Your Risk

Liver Cirrhosis (Liver Scarring): Causes, Symptoms and Prevention

Liver Inflammation: What Causes It and How to Prevent

Fat Buildup in the Liver: Why It's Bad for You

Fatty Liver Disease: How to Reverse It

10 Ways to Keep Your Liver Healthy