A major component of health screening involves cancer screening.
The liver is an organ that never stops working, yet most of the time, we pay minimal attention and care to it. The liver plays numerous pivotal roles ranging from aiding digestion, protein and enzyme production, and detoxifying the body.
Even with a minor liver injury, insult, or stress, the liver continues to stay resilient and functions without symptoms. It is only when the liver is more than 2/3 damaged that symptoms start to show. Hence, taking care of the liver is paramount. In this article, we discuss a common reversible cause of liver damage—fatty liver disease.
The liver is located just below the lungs and over the right upper part of the abdomen –the region is also known as the right hypochondrium. It plays a vital role in:
Fatty liver disease, also known as steatosis of the liver, is a medical condition that occurs due to the accumulation of fat in the liver. There are two types of fatty liver disease, these are:
There is a strong association of NAFLD with metabolic conditions such as obesity, hypertension, diabetes, and dyslipidaemia. Some medical journals suggest fatty liver is the hepatic manifestation of metabolic syndrome.
Non-alcoholic fatty liver disease occurs in approximately 40% of Singaporeans and comprises four different stages, these are:
Patients with a fatty liver are usually asymptomatic. However, if you notice the following symptoms, it could be a sign that your fatty liver disease has progressed:
If you notice the above symptoms, make an appointment with your doctor immediately.
Non-alcoholic fatty liver disease is associated with the build-up of excess fats in the liver. This occurs when more calories are consumed than the body can use, the excess calories are converted to fats and stored in the liver. When the amount of fats in the liver is more than 5% of the liver’s weight, then fatty liver disease occurs.
This means that individuals are more predisposed to fatty liver disease if they have:
As most patients are asymptomatic, routine health screening or a medical checkup is encouraged to screen for metabolic syndrome and NAFLD. You are encouraged to discuss with your doctor on your possible risk factors and what can be done to reduce your risk of developing fatty liver disease.
Medical conditions that increase an individual’s risk for developing NAFLD include:
With the rise of metabolic syndrome, obesity, and diabetes, the cases of NAFLD are rising exponentially as well. Currently NAFLD is becoming the most common cause of liver disease in the world. A study conducted in 2022 found that the prevalence of NAFLD is estimated to be 32.4%, with numbers expected to grow.
In Singapore, the prevalence can be as high as 40%. Interestingly, not only can NAFLD be seen in obese people, but also in 20% of non-obese Asians.
As NAFLD can progress into irreversible complications such as cirrhosis (severe scarring of the liver), regular routine screening is important in the prevention of fatty liver disease.
Once an individual has developed liver cirrhosis, further complications may occur such as a buildup of abdominal fluid (ascites), oesophageal vein swelling and rupture (varices), liver encephalopathy (with change of mental state, confusion, drowsiness), increased risk of liver cancer (hepatocellular carcinoma), and end stage liver failure.
Hence, it is very important to detect and treat NAFLD when it is still in its early, reversible stages. Thankfully, the progression of the condition is generally slow, and most NAFLD patients are stable and can be managed in primary care. Do speak to your doctor to screen for NAFLD.
Fatty liver can go undiagnosed for years as it usually does not cause pain or other symptoms. One usually picks up fatty liver findings during routine blood tests.
If your results are concerning to your doctor, he/she may arrange an ultrasound of the liver. In severe cases, your doctor may refer you to a gastroenterologist who will then advise for a liver fibroscan or biopsy for further evaluation of the extent or severity of your fatty liver disease.
You should consider screening for fatty liver/NAFLD if you have any of the following conditions:
Your doctor will usually take your medical history and examine you physically— covering blood pressure, weight, height, waistline measurement, etc. Depending on how you fare, your cardiovascular organs and liver may also be screened.
Subsequently, blood tests which cover the general screening, and a liver function test are conducted to screen for metabolic syndrome and fatty liver disease. Depending on your individual risk factors, you may also be required to have imaging (e.g., ultrasound, CT scan, MRI) taken of your liver. You can discuss your concerns with your doctor regarding NAFLD and decide on any suitable tests for further evaluation.
NAFLD is a reversible condition if managed early, below are some steps you can take to reverse or prevent fatty liver disease.
Medications: medication may be prescribed for the concurrent management of diabetes, cholesterol, or blood pressure problems. Medications may also be prescribed to individuals with recalcitrant visceral fat/chronic elevated BMI in order to facilitate weight loss.