Understanding Metabolic Dysfunction-Associated Fatty Liver Disease

According to the National Health & Morbidity Survey 2023, around 28.2% (6.7 million) of Malaysian adults are affected by Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD).

Formerly known as non-alcoholic fatty liver disease (NAFLD), this is a condition attributed to the build-up of excess fat in the liver, commonly referred to as fatty liver. This condition is associated with metabolic dysfunction and is not caused by heavy alcohol consumption.

MAFLD can lead to severe liver damage and is linked to other health issues such as diabetes, high blood pressure, heart disease, chronic kidney disease, cancer, and various other complications.

MAFLD is more prevalent in men, affecting 32% of males compared to 25% of females, with the average age of those diagnosed being 42 years old.

Stages of MAFLD

Steatosis (simple fatty liver)	A large accumulation of fat within the liver cells. It is harmless and may only be diagnosed during tests done for other reasons.
Non-alcoholic steatohepatitis (NASH)	A more severe form of MAFLD characterised by liver inflammation.
Fibrosis	Persistent inflammation leads to scar tissue forming around the liver and nearby blood vessels. The liver is still able to function properly.
Cirrhosis	The most severe stage that happens after years of inflammation. The liver shrinks and turns scarred and lumpy. The damage is permanent and can cause liver failure (liver stops functioning properly) and liver cancer.

Symptoms of MAFLD

This condition is typically asymptomatic in the early stages. An individual is probably unaware of the condition unless it is diagnosed during tests performed for other reasons.

Individuals with NASH or fibrosis may experience a mild or aching pain in the top right part of the abdomen (over the lower right side of the ribs), extreme exhaustion, unexplained weight loss, and weakness.

If cirrhosis (the most advanced stage) develops, more serious symptoms may occur which include jaundice (yellowing of the skin and the whites of the eyes), itchy skin, and oedema (swelling in the legs, ankles, feet, or tummy).

Risk Factors of MAFLD

You are at an increased risk of developing fatty liver disease if you have any of the below:

Obesity (excess body weight, especially abdominal obesity and excess body fat around the waist)
Metabolic syndrome (a cluster of conditions including high blood pressure, high blood sugar, and high cholesterol or triglyceride levels)
Sedentary lifestyle
Diet high in sugar, refined carbohydrates, and saturated fats
Smoking
Underlying medical condition – e.g., Polycystic Ovary Syndrome (PCOS) and underactive thyroid (hypothyroidism). PCOS is associated with insulin resistance and obesity. Hypothyroidism can lead to metabolic slowing and weight gain, increasing the risk of MAFLD.

Diagnosing Fatty Liver Disease

A combination of medical history, physical examination, laboratory tests, and imaging studies will be performed for diagnosis.

Tests	Details
Laboratory tests	Blood test - liver enzyme tests (ALT, AST), bilirubin, and albumin levels. High levels of liver enzymes may indicate liver inflammation or damage. Lipid profile test (cholesterol, triglycerides) to help identify metabolic risk factors. Glucose tests (fasting blood sugar, HbA1c) to help diagnose diabetes or insulin resistance. Additional tests (for hepatitis viruses or autoimmune liver diseases) to rule out other causes of liver disease.
Imaging studies	Ultrasound is used to show liver size and the presence of fat but may not provide detailed information on the extent of liver damage. A CT scan can detect fat and other abnormalities in the liver. An MRI scan can provide detailed images of liver fat content and structure. A specialised ultrasound called FibroScan (Transient Elastography) is used to measure liver stiffness, which can help assess the degree of fibrosis (scarring).
Liver biopsy	Involves removing a small sample of liver tissue using a needle, which is then examined under a microscope to determine the severity of liver damage.

Treating and Preventing Fatty Liver Disease

The treatment of MAFLD focuses on managing underlying risk factors and adopting lifestyle changes to improve liver health and prevent liver disease, which include:

Healthy and balanced diet and control portion sizes.
Maintain a healthy weight.
Regular physical activity.
Maintain good control of blood sugar, cholesterol, and triglyceride levels within the normal range through diet, exercise, and medications (if prescribed).

There are no specific medications approved to treat fatty liver disease directly at the moment. However, certain medications may be prescribed to manage associated conditions and reduce liver inflammation and damage.

Advanced treatments such as liver transplant may be necessary in cases where MAFLD has progressed to significant liver damage, such as cirrhosis or liver failure.

Make an Appointment at Gleneagles Hospitals

Get in touch with us to book an appointment today if you have concerns or questions regarding Metabolic Dysfunction-Associated Fatty Liver Disease. A dedicated and expert team of gastroenterology and hepatobiliary specialists at Gleneagles Hospitals is available for consultation to provide the best care and assistance. We assure you the best possible care tailored to your specific needs.

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