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Education & Research

Fatty Liver

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Health Bytes: 

You may have heard friends or family members, or perhaps your doctor telling you that they/you have fatty liver. What does fatty liver mean to me? What should I do and how does it affect me?

Fatty liver refers to the accumulation of fats in the liver cells. It leads to a spectrum of conditions ranging from uncomplicated simple fatty liver, steatohepatitis (active liver inflammation) and even cirrhosis (liver hardening) resulting in hepatocellular carcinoma (liver cancer). Worryingly, fatty liver is an increasingly common condition in Singapore.

People with fatty liver have about 30% higher risk of suffering from a cardiovascular event (stroke or heart attack) than the average population. Also, in some people who have a form of fatty liver causing liver inflammation (steatohepatitis), they may go on to develop liver hardening (cirrhosis) and hepatocellular carcinoma (liver cancer). They should be screened for diabetes mellitus, high cholesterol (dyslipidaemia), high blood pressure (hypertension) and have their BMI (body mass index) measured. An obese person is almost 5 times more likely to suffer from fatty liver, and about 50% of patients with metabolic syndrome also suffer from fatty liver.

The prevalence of fatty liver in Asian countries are between 15-40%.  There is no good data on its prevalence in Singapore. Local epidemiology data should be available soon.

Viral hepatitis B is the commonest cause of chronic liver disease in Singapore, although prevalence has dropped due to national vaccination implemented in 1987. Despite this, liver cancer remains the 4th commonest cancer in Singaporean men. This is due to an increase in patients with fatty liver disease.

This is the result of lipid (fat) metabolism. Excessive amounts of carbohydrates and fats result in deposition of lipids in the liver cells. There is also a problem with insulin sensitivity in most cases. With sedentary lifestyles and rich food intake a common occurrence in our local population, it is unsurprising that the incidence of fatty liver is rising steadily.

The key to management of fatty liver is the optimal control of cardiovascular risk factors such as controlling hypertension, cholesterol and diabetes. Very importantly, regular exercise of about 20 minutes up to 3-4 sessions per week should be performed. Studies have shown exercise to be the most effective treatment of fatty liver. Even when there is no weight reduction, exercise has shown to reduce rates of cirrhosis and degree of inflammation.

Medications for the treatment of fatty liver have been disappointing so far. There are no firm recommendations for routine use of Vitamin E, pioglitazone, metformin, pentoxyfillin etc. However, the use of Atorvastatin (cholesterol medication) has shown to reduce rates of heart attacks and strokes in patients with fatty liver. Trials are still ongoing to identify the efficacious medications for fatty liver treatment.

There is good news for coffee lovers. Consumption of 3 or more cups of coffee daily has shown to reduce rates of liver cancer, inflammation and progression of cirrhosis. If you are thinking of substituting tea for coffee, you will be disappointed as studies for tea were dismal. Caffeine was not identified to confer protection. 

In summary, patients with fatty liver should be screened for metabolic syndrome. They have higher risk of cardiovascular events such as heart attacks and strokes. The most effective treatment for fatty liver is exercise and weight loss. Cholesterol medications such as Atorvastatin has shown to reduce rates of cardiovascular events. And you can continue to enjoy your cup of coffee with each meal every day, but remember to reduce the amount of sugar and condensed milk!

 

Dr Poh Zhongxian Adrian

Frontier Medical Associates (Jurong West)

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