Mr. Wang, 28 years old, is an engineer at the Southern Taiwan Science Park. He is generally healthy, with no habits of smoking, drinking, or taking traditional Chinese medicine, and no history of chronic diseases. Due to his busy work schedule, he often eats out and lacks exercise, leading to gradual weight gain. During a company health check-up, it was unexpectedly found that his liver enzyme levels were elevated (AST/ALT: 69/86), and an ultrasound showed severe fatty liver. Mr. Wang immediately sought medical treatment.
After examination and blood tests, the results showed no viral hepatitis B or C, nor other autoimmune or metabolic disorders. Given Mr. Wang's height of 175 cm and weight of 85 kg, with a BMI of 27.7 kg/m², elevated triglycerides, and low-density cholesterol, he was diagnosed with metabolic-associated fatty liver disease (MAFLD).
Dr. Chen Ji-Hsing, a gastroenterology and hepatology specialist at Chi Mei Hospital, recommended that Mr. Wang start by adjusting his diet, avoiding sugary drinks and fried foods, eating more fruits and vegetables, and exercising at moderate intensity five days a week for at least 30 minutes each time. Three months later, Mr. Wang lost 5 kg, his liver enzyme levels gradually decreased, and his fatty liver improved from severe to moderate. Dr. Chen advised Mr. Wang to maintain these habits until his weight returns to the normal range and to regularly monitor his liver enzyme levels until they return to normal.
Preventing fatty liver starts with changing your lifestyle. (Image provided by Heho Health)
The Dangers of Fatty Liver
Dr. Chen Ji-Hsing warns that fatty liver should not be ignored, as it can develop into hepatitis. Hepatitis refers to inflammation of the liver caused by various factors, resulting in liver cell damage, including viral hepatitis (types A, B, C, D, and E) and non-viral hepatitis (such as alcoholic hepatitis, drug-induced hepatitis, and non-alcoholic hepatitis). Non-alcoholic fatty liver disease (NAFLD) refers to the accumulation of fat in liver cells, where fat content exceeds 5% of the total liver weight.
The Relationship Between Fatty Liver and Metabolic Syndrome
In recent years, with the westernization of the diet, the prevalence of fatty liver and metabolic syndrome has increased. If not timely managed, fatty liver can lead to steatohepatitis, cirrhosis, and even liver cancer. Studies indicate that the prevalence of fatty liver in Taiwan is about 33.3%, with approximately 5.3 deaths per year due to fatty liver. According to the 2023 statistics from the Ministry of Health and Welfare, about 80% of liver cancer cases are caused by viral hepatitis B and C, and 20% by fatty liver.
With the nationwide implementation of hepatitis B vaccination for newborns and the high cure rate of oral medications for hepatitis C, the prevalence of viral hepatitis is gradually decreasing. Dr. Chen Ji-Hsing points out that metabolic-associated fatty liver disease (MAFLD) is often overlooked and silently progresses into the chronic liver disease triad (hepatitis, cirrhosis, and liver cancer).
Diagnosis of Metabolic-Associated Fatty Liver Disease
Since 2020, global experts have agreed to replace the term "non-alcoholic fatty liver disease (NAFLD)" with "metabolic-associated fatty liver disease (MAFLD)" to emphasize the relationship between fatty liver and metabolic disorders. MAFLD is diagnosed by the presence of fatty liver and any one of the following conditions: overweight (BMI ≥ 23 kg/m²), type 2 diabetes, or two metabolic abnormalities (excessive waist circumference, high blood pressure, elevated triglycerides, reduced high-density cholesterol, pre-diabetes, high insulin resistance, and elevated C-reactive protein).
Patients with metabolic syndrome have a higher risk of developing diabetes, hypertension, hyperlipidemia, cardiovascular disease, stroke, and cardiogenic death compared to those without metabolic syndrome. Fatty liver is the hepatic manifestation of metabolic syndrome.
Diagnosis and Treatment of Fatty Liver
Ultrasound is commonly used for diagnosing fatty liver, but it cannot determine the inflammatory status of liver cells. Diagnosis of steatohepatitis requires a liver biopsy, which, although invasive, has high sensitivity and specificity. The Fibroscan is a non-invasive tool for assessing liver fibrosis and quantifying fatty liver, taking about 5 to 10 minutes and costing around NT$1,000 to NT$2,000.
Currently, there are no specific medications for treating fatty liver. The primary approach is to improve metabolic syndrome and insulin resistance through dietary control, exercise, and weight loss.
Regular exercise can prevent fatty liver. (Image provided by Heho Health)
The Dangers of Fatty Liver
Dr. Chen Ji-Hsing warns that fatty liver should not be ignored, as it can develop into hepatitis. Hepatitis refers to inflammation of the liver caused by various factors, resulting in liver cell damage, including viral hepatitis (types A, B, C, D, and E) and non-viral hepatitis (such as alcoholic hepatitis, drug-induced hepatitis, and non-alcoholic hepatitis). Non-alcoholic fatty liver disease (NAFLD) refers to the accumulation of fat in liver cells, where fat content exceeds 5% of the total liver weight.
The Relationship Between Fatty Liver and Metabolic Syndrome
In recent years, with the westernization of the diet, the prevalence of fatty liver and metabolic syndrome has increased. If not timely managed, fatty liver can lead to steatohepatitis, cirrhosis, and even liver cancer. Studies indicate that the prevalence of fatty liver in Taiwan is about 33.3%, with approximately 5.3 deaths per year due to fatty liver. According to the 2023 statistics from the Ministry of Health and Welfare, about 80% of liver cancer cases are caused by viral hepatitis B and C, and 20% by fatty liver.
With the nationwide implementation of hepatitis B vaccination for newborns and the high cure rate of oral medications for hepatitis C, the prevalence of viral hepatitis is gradually decreasing. Dr. Chen Ji-Hsing points out that metabolic-associated fatty liver disease (MAFLD) is often overlooked and silently progresses into the chronic liver disease triad (hepatitis, cirrhosis, and liver cancer).
Diagnosis of Metabolic-Associated Fatty Liver Disease
Since 2020, global experts have agreed to replace the term "non-alcoholic fatty liver disease (NAFLD)" with "metabolic-associated fatty liver disease (MAFLD)" to emphasize the relationship between fatty liver and metabolic disorders. MAFLD is diagnosed by the presence of fatty liver and any one of the following conditions: overweight (BMI ≥ 23 kg/m²), type 2 diabetes, or two metabolic abnormalities (excessive waist circumference, high blood pressure, elevated triglycerides, reduced high-density cholesterol, pre-diabetes, high insulin resistance, and elevated C-reactive protein).
Patients with metabolic syndrome have a higher risk of developing diabetes, hypertension, hyperlipidemia, cardiovascular disease, stroke, and cardiogenic death compared to those without metabolic syndrome. Fatty liver is the hepatic manifestation of metabolic syndrome.
Diagnosis and Treatment of Fatty Liver
Ultrasound is commonly used for diagnosing fatty liver, but it cannot determine the inflammatory status of liver cells. Diagnosis of steatohepatitis requires a liver biopsy, which, although invasive, has high sensitivity and specificity. The Fibroscan is a non-invasive tool for assessing liver fibrosis and quantifying fatty liver, taking about 5 to 10 minutes and costing around NT$1,000 to NT$2,000.
Currently, there are no specific medications for treating fatty liver. The primary approach is to improve metabolic syndrome and insulin resistance through dietary control, exercise, and weight loss.
