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Health and wellness

Fatty liver disease is the ticking time bomb you’ve never heard of – here’s what you can do about it

The condition is catching up with alcohol use as the leading cause of liver disease in developing countries. Being obese is the biggest indicator, but it is not confined to the overweight. How to lower your chances of getting it

PUBLISHED : Tuesday, 22 May, 2018, 8:00pm
UPDATED : Wednesday, 23 May, 2018, 7:41pm

It has been called “the most common disease you’ve never heard of”, affecting one in four people – more than sufferers of diabetes and arthritis combined. The trouble is, many people who have it do not have any symptoms, and discover the problem only when it is at an advanced stage. It is fatty liver disease, and the number of people afflicted is rising.

Cirrhosis of the liver – in which scar tissue replaces the liver’s healthy cells, diminishing its ability to function – is common in alcoholics, and usually starts out as fatty liver disease, a build-up of fat in the organ. What few people realise is that even non-drinkers can develop fatty livers, or non-alcoholic fatty liver disease (NAFLD).

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Vanessa Hebditch, director of policy and communications at the British Liver Trust, says the biggest indicator for having NAFLD is being overweight.

“With almost one third of adults overweight, the British Liver Trust estimates it will have overtaken alcohol as the leading cause of liver disease in the United Kingdom by 2020. It has already happened in the US.”

She calls the disease a “time bomb”, for good reason. “In just 50 years, a little more than a generation, figures are expected to have risen fourfold. The problem is there are often no real symptoms and 75 per cent of conditions are diagnosed in hospital settings when it is at an advanced stage.”

Dr Paul Ng, a Hong Kong-based specialist in gastroenterology and hepatology, sees a link between the disease’s incidence and affluence. In Hong Kong, 27 per cent of the population – a number that rises year on year – is estimated to have this disease, among whom four per cent have advanced fibrosis or cirrhosis. In poorer rural China, he says, “it’s virtually unknown”.

Taking the fight to liver disease

Eating too much and moving too little predisposes a person to the condition, as do having diabetes and high cholesterol. But it is not immediately obvious. And thin people are not immune.

Ng says some people are “skinny fat” and have a high-fat body composition despite an apparently lean appearance; some may be genetically more susceptible to having NAFLD.

Professor Vincent Wong of the Department of Medicine and Therapeutics at the Chinese University of Hong Kong says that, while most fatty liver patients are overweight or obese, it also occurs in around 10 per cent to 20 per cent of people with a relatively normal body mass index.

How do you know you have fatty liver disease – even if you’re slender? Some people have symptoms such as nausea, abdominal pain and fatigue, but many patients show no signs. Available liver function tests include blood tests, ultrasound, CT or MRI scanning, and a special scan called a “controlled attenuation parameter”.

Ng says the waistline can be predictive. Men whose waists are 84 centimetres (33 inches) or more and women whose waists are 74cm (29in) or more are at greater risk.

Whether a fatty liver is a health danger or not depends on the severity, says Ng. Mild cases are usually harmless, while severe cases can kill – “typically from a heart attack or stroke as these patients run higher risks of having coronary heart disease”.

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Wong says a small proportion of NAFLD patients may develop non-alcoholic steatohepatitis (Nash), a fatty liver plus liver inflammation and injury, which can progress to life-threatening cirrhosis and liver cancer. The British Liver Trust believes that Nash incidence “could be significantly higher than we thought, and potentially even higher than Type 2 diabetes in the over-40s”, says Hebditch.

“It’s important to detect severe fatty liver early and manage it accordingly,” Wong warns. At least 60 per cent of patients with fatty liver can eradicate the condition with changes to their lifestyle, he adds.

As with most ailments, recovery stems from wise food choices and increased physical activity.

Hong Kong-based dietitian Denise Fair advises clients to watch their intake of simple sugars. These include glucose, fructose, sucrose and plain white table sugar.

“These get metabolised and packaged into triglycerides and can cause fat to be stored in the liver cells – so really watch those candies, cakes, pastries, chocolates and all those other yummy things,” she says. You may not be aware that “the majority of us get the most simple sugars from what we drink, and not from what we eat”, she warns.

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Another key dietary change, Fair says, “should be watching the types of fat you eat. It is important to lower – but not eliminate – your meat intake, for example, to lower your saturated fat intake. Similarly, watch out for those processed fats – or trans fats; you’ll find those in most packaged foods and baked goods. These fats act differently in our body and accumulate in the liver.”

She also urges clients to get moving, as exercise prompts weight loss. “Isotonic is best”, Fair says, and includes squats, stair climbing, bicep curls and push-ups. “Think aerobic cardio exercises,” she says, noting isometric exercise – in which you hold a position, as in many yoga poses, or planks and side bridges – is less helpful. Even a 10 per cent weight loss can have marked differences on a fatty liver.

Ng offers encouragement, noting a fatty liver is curable, “not by a doctor, but by the patients themselves”.

The disease can bounce back if they slip into bad old habits, he warns, adding, “An ongoing effort is needed to maintain the ‘cure’.”

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Four key things you may not know about your liver

1. It is the body’s largest gland.

2. It is the largest solid organ, weighing between 1.44kg and 1.66kg.

3. It is the only organ that is self-healing; as little as a quarter of the original mass can regenerate itself back to full size.

4. It has more than 500 roles, including:

– removing toxins from the bloodstream

– processing nutrients

– balancing protein, fat and sugar in the blood

– destroying old red blood cells and disease-causing agents

– producing chemicals to help clot blood

– breaking down and metabolising alcohol and medicines

– producing essential proteins and cholesterol