Fatty Liver
Dr. John Hsiang is a distinguished gastroenterologist in Singapore with extensive training and experience in digestive health. He obtained his Fellowship of the Royal Australasian College of Physicians in Gastroenterology in 2012 and holds a PhD in viral hepatitis and fatty liver disease research.
He provides care for a broad range of digestive and liver concerns, combining thorough evaluation with tailored management to support patients’ long-term well-being.
Dr Hsiang is skilled in performing gastroscopy (upper endoscopy) and colonoscopy to investigate symptoms, detect stomach and colon cancers at an early stage, and provide timely treatment options.
With a commitment to individualised care, he applies an evidence-based approach that prioritises accuracy, effectiveness and patient comfort at every stage of diagnosis and treatment.
Languages Spoken:
English, Mandarin and Hokkien
Fellowship Trained Specialist
20+ Years of Clinical Experience
What is Fatty Liver Disease?
Fatty liver disease, medically known as hepatic steatosis, is a common condition characterised by the accumulation of excess fat in liver cells. While it is normal for the liver to contain some fat, if fat makes up more than 5-10% of the liver’s weight, it is considered fatty liver. This condition is increasingly recognised as a significant public health concern globally, affecting a substantial portion of the population.
Early detection and management are crucial, as fatty liver can progress to more severe forms of liver disease, including inflammation, scarring (fibrosis), cirrhosis, and even liver failure or liver cancer.
Causes and Risk Factors
In its early stages, fatty liver disease is often asymptomatic, meaning it presents with no noticeable symptoms. It may be discovered incidentally during routine blood tests that show elevated liver enzymes, or during imaging studies for other conditions.
Symptoms
As the disease progresses, particularly if inflammation and damage occur (NASH or alcoholic steatohepatitis), symptoms may begin to appear:
- Fatigue and Weakness
- Dull or aching pain in the upper right abdomen (where the liver is located)
- Unexplained weight loss
- Nausea or loss of appetite
In more advanced stages, when cirrhosis develops, symptoms become more severe and include:
- Jaundice: Yellowing of the skin and eyes.
- Dark urine and pale stools.
- Swelling in the legs and ankles (edema).
- Fluid accumulation in the abdomen (ascites).
- Easy bruising or bleeding.
- Confusion or disorientation (hepatic encephalopathy).
- Spider-like blood vessels on the skin (spider angiomas).
Risk Factors
Understanding the underlying causes and risk factors is essential for both prevention and management.
Non-Alcoholic Fatty Liver Disease (NAFLD) NAFLD is strongly associated with metabolic syndrome and its components:
- Obesity: Especially central obesity (fat around the waist).
- Type 2 Diabetes Mellitus: Insulin resistance plays a central role.
- Insulin Resistance: When the body’s cells don’t respond properly to insulin, leading to high blood sugar levels.
- Dyslipidemia: High levels of triglycerides and abnormal cholesterol levels (low HDL, high LDL).
- Metabolic Syndrome: A cluster of conditions including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.
- Other Factors: Rapid weight loss, certain medications (e.g., amiodarone, tamoxifen), sleep apnea, polycystic ovary syndrome (PCOS), and genetic predisposition.
Alcoholic Liver Disease (ALD) The primary cause of ALD is chronic, heavy alcohol consumption. The amount of alcohol that leads to liver damage varies among individuals, but generally, higher and more prolonged intake increases the risk.
Types of Fatty Liver Diseases
Fatty liver disease is broadly categorised into two main types based on its cause:
Non-Alcoholic Fatty Liver Disease (NAFLD): This is the most common type and occurs in individuals who consume little to no alcohol. NAFLD encompasses a spectrum of conditions:
- Non-Alcoholic Fatty Liver (NAFL): Simple fatty liver without significant inflammation or liver cell damage. This form typically does not progress to severe liver disease.
- Non-Alcoholic Steatohepatitis (NASH): A more severe form of NAFLD characterised by fat accumulation accompanied by inflammation and liver cell damage. NASH can lead to fibrosis, cirrhosis, and liver cancer.
Alcoholic Liver Disease (ALD) / Alcohol-Related Fatty Liver Disease: This type is caused by excessive alcohol consumption. Alcohol is metabolised in the liver, and this process can generate harmful substances that damage liver cells and promote fat accumulation. Like NAFLD, ALD can progress from simple fatty liver to alcoholic steatohepatitis, alcoholic cirrhosis, and liver failure.
How to Manage Fatty Liver Disease?
The cornerstone of fatty liver management is addressing the underlying causes. Treatment strategies often involve a combination of lifestyle modifications and, in some cases, pharmacological interventions.
Lifestyle Modifications:
Weight Loss:
- Gradual and sustained weight loss (7-10% of body weight) is the most effective intervention for NAFLD and can improve liver enzymes, reduce fat, inflammation, and even reverse fibrosis.
Healthy Diet:
- Reduced Calorie Intake: To promote weight loss.
- Limit Sugary Drinks and Refined Carbohydrates: These contribute to fat accumulation.
- Increase Fiber Intake: From fruits, vegetables, and whole grains.
- Emphasis on Healthy Fats: Monounsaturated and polyunsaturated fats (e.g., olive oil, avocados, nuts, fatty fish).
- Consider a Mediterranean Diet: Rich in fruits, vegetables, whole grains, lean protein, and healthy fats.
Regular Physical Activity:
- Aim for at least 150 minutes of moderate-intensity exercise per week. Exercise helps reduce liver fat, improves insulin sensitivity, and aids in weight management.
Alcohol Abstinence (for ALD):
- Complete cessation of alcohol is crucial for individuals with ALD. For NAFLD patients who consume alcohol, moderation or reduction is advised.
When to Consult a Gastroenterologist
In its early stages, fatty liver disease is often asymptomatic, meaning it presents with no noticeable symptoms. It may be discovered incidentally during routine blood tests that show elevated liver enzymes, or during imaging studies for other conditions.
It is therefore important to consult an experienced gastroenterologist. They can accurately diagnose your condition, rule out other serious issues, and develop a personalised management plan to help you find relief and prevent complications.
Our Treatment Process
Regular follow-up with a gastroenterologist is essential to monitor liver health, assess disease progression, and screen for complications like cirrhosis or HCC, especially in high-risk individuals.
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Patient Information
Do I need a liver biopsy to confirm fatty liver?
Not usually. Most cases are diagnosed through imaging and blood tests. A liver biopsy may be recommended only if:
- There’s concern about liver scarring (fibrosis or cirrhosis).
- Other liver conditions need to be ruled out.
- Non-invasive results are inconclusive.
Can I reverse fatty liver with treatment?
Yes. With proper management:
Losing 5–10% of body weight can significantly reduce liver fat.- Structured weight-loss programmes and diet advice are widely available.
- Ongoing monitoring through blood tests and FibroScan helps track improvement
Most private and public clinics offer annual follow-ups and lifestyle support.
What treatments are available for fatty liver?
Currently, there are no approved medications specifically for fatty liver in Singapore. Treatment focuses on lifestyle changes:
- Weight loss through a dietitian-guided programme.
- Exercise (at least 150 minutes/week).
- Control of diabetes, cholesterol and blood pressure.
- Doctors may also prescribe medications for related conditions (e.g. statins for cholesterol).
Consult Our Specialist
Experiencing digestive symptoms or discomfort? Speak to our gastroenterologist for a clearer understanding of your condition and treatment options.
You may book an appointment using our contact form or call the clinic at 6517 9958
