Those who are at risk should take liver health seriously, even if they feel well. Prioritise regular check-ups and healthy habits.
Without intervention, fatty changes in the liver precipitate changes that could have catastrophic consequences.
Doctors are seeing an alarming rise in fatty liver disease, no thanks to prevailing lifestyles and diets, and rising obesity rates. Now called metabolic dysfunction-associated fatty liver disease (MAFLD), this disorder affects an estimated one in four adults worldwide.
Consultant gastroenterologist and hepatologist at Sunway Medical Centre, Sunway City, Dr Wong Lin Lee and Dr Khoo Stanley say that in South-East Asia, the numbers are worse, with an estimated one in three adults having MAFLD.
In Malaysia, the situation appears a bit more dire. “Our National Health and Morbidity Survey 2023 found that 54% of Malaysians were overweight and obese. This means that many have the condition because of the intrinsic link between both conditions,” surmises Dr Wong. This makes it a major public health issue, not just because it is common, but because of the long-term implications of unmanaged MAFLD.
Dr Wong says MAFLD does not usually result in symptoms and the only way to know its presence is through screening.
Dr Khoo says the liver is usually a very robust organ that carries out multiple vital functions in the body.
“MAFLD is often described as a ‘silent disease’, and for good reason. You can lose 70-80% of liver function without having any symptoms. By the time fatigue, abdominal discomfort, or jaundice appear, the disease may already be in a more serious stage,” warns Dr Khoo.
Dr Khoo says long-term damage develops slowly but steadily, especially in individuals with ongoing metabolic risks.
Several factors are driving this surge in MAFLD, observes Dr Wong. “The most significant are obesity, sedentary habits, and diets high in sugar, refined carbohydrates, and processed foods. Genetic risk factors also play a role.”
However, MAFLD can also occur in individuals who are not overweight, as well as those with other medical, lifestyle or past-exposure risk factors. Genetics, high cholesterol, insulin resistance and diabetes can all contribute. Similarly, while drinking alcohol can cause fatty liver disease, MAFLD can occur without any alcohol use, the two doctors inform.
“Because MAFLD does not usually result in symptoms, most times, the only way to know is through screening. Patients can go for a simple blood test and an ultrasound,” says Dr Wong. More advanced tests such as a transient elastography can assess liver stiffness and fat levels more accurately, helping determine whether inflammation or fibrosis has already begun.
Dr Khoo says that without proper management, fatty liver can progress stealthily. “This begins with simple fat accumulation, then inflammation, then healing. For some people, repeated cycles of this can lead to fibrosis (liver scarring). Over time, liver function deteriorates, and eventually, cirrhosis may develop, where the liver becomes stiff, shrunken, and less able to function.
“Cirrhosis cannot be reversed, and in its most severe form, it may progress to liver failure or liver cancer. This long-term damage develops slowly but steadily, especially in individuals with ongoing metabolic risks.
“The metabolic aspects are intrinsic. Being overweight or obese contributes to fatty accumulation, not just in the liver, but also elsewhere. That’s why the condition is not just a liver problem. It is a systemic problem involving the whole body, hence the term MAFLD instead of fatty liver disease.
“It is worth noting that fat deposits in the liver reflect higher risk of heart disease and stroke. In fact, the highest cause of deaths in those with MAFLD is from heart attacks.”
Both doctors emphasise that not all is doom and gloom. The good news: fatty liver is often reversible, especially when detected early.
“Lifestyle changes remain the most effective treatment. Weight loss, even a modest 10% reduction, can significantly reduce liver fat and inflammation. A balanced diet low in sugar and saturated fats, regular physical activity, and better control of diabetes or cholesterol can improve liver health,” they advise.
For those who have fatty liver, long term follow up is necessary. Routine screening and follow-up are powerful tools in preventing complications like cirrhosis or liver cancer. Early detection allows doctors to monitor changes, guide lifestyle interventions and treat problems before they escalate, both doctors emphasise.
And while “detox diets” and liver-cleansing supplements are popular, they are not scientifically proven and may even harm the liver, observes Dr Wong. The safest and most effective approach remains evidence-based lifestyle modification, medical supervision and early screening.
The key message is simple: take liver health seriously, even if you feel well. Prioritise regular check-ups and healthy habits. And for those who are overweight, have metabolic risk factors such as high blood pressure, high cholesterol, heart disease and diabetes, or drink alcohol, Dr Khoo advises getting their liver health assessed.
