Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)

Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD), previously known as non-alcoholic fatty liver disease (NAFLD), is a condition characterised by the accumulation of excess fat in the liver, or commonly referred to as fatty liver. It is linked to metabolic dysfunction and is not attributed to heavy alcohol consumption.

According to the National Health & Morbidity Survey 2023, three in 10 or 28.2% (6.7 million) adults in Malaysia have MAFLD. This disease can lead to serious liver damage, and it is also associated with diabetes, high blood pressure, heart disease, chronic kidney disease, cancers, and other health problems.

MAFLD is more common in men, affecting 32% of men compared to 25% of women. The average age of individuals with MAFLD is 42 years.

What are the stages of MAFLD?

Here are the four main stages of fatty liver disease:

Steatosis: Steatosis or simple fatty liver is 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): This is a more severe form of MAFLD characterised by liver inflammation.
Fibrosis: At this stage, persistent inflammation leads to scar tissue forming around the liver and nearby blood vessels. However, the liver is still able to function properly.
Cirrhosis: This is 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.

What are the symptoms of MAFLD?

In the early stages, there are typically no noticeable symptoms. You are probably unaware of your condition unless it is diagnosed during tests conducted for other reasons.

Sometimes, 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
Weakness

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

What are the risk factors of fatty liver disease?

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, significantly increases the risk.
Type 2 diabetes: Insulin resistance and elevated blood sugar levels are strongly associated with MAFLD.
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.
High cholesterol and triglycerides: Elevated levels of fats in the blood can contribute to the development of MAFLD.
Sedentary lifestyle: Lack of physical activity can lead to weight gain and metabolic imbalances.
Poor diet: Diets high in sugar, refined carbohydrates, and saturated fats can contribute to fat accumulation in the liver.
Polycystic Ovary Syndrome (PCOS): A hormonal disorder common among women of reproductive age that is associated with insulin resistance and obesity.
Underactive thyroid (Hypothyroidism): This condition can lead to metabolic slowing and weight gain, increasing the risk of MAFLD.
Smoking

How is MAFLD diagnosed?

Diagnosing MAFLD typically involves a combination of medical history, physical examination, laboratory tests, and imaging studies.

Laboratory tests

Blood tests: To evaluate liver function and look for signs of liver damage. Common tests include liver enzyme tests (ALT and AST), bilirubin, and albumin levels. High levels of liver enzymes may indicate liver inflammation or damage.
Lipid profile test (cholesterol and triglycerides): To help identify metabolic risk factors.
Glucose tests (fasting blood sugar and HbA1c): To help diagnose diabetes or insulin resistance.
Additional tests may include checking for hepatitis viruses or autoimmune liver diseases to rule out other causes of liver disease.

Imaging studies

Ultrasound: This is often the first imaging test used to detect fat in the liver. It can show liver size and the presence of fat but may not provide detailed information on the extent of liver damage.
Computed Tomography (CT) Scan: A CT scan can detect fat and other abnormalities in the liver.
Magnetic Resonance Imaging (MRI): MRI is more sensitive than ultrasound and can provide detailed images of liver fat content and structure.
FibroScan (Transient Elastography): This specialised ultrasound measures liver stiffness, which can help assess the degree of fibrosis (scarring).

Liver biopsy

A liver biopsy may be necessary to confirm the diagnosis and assess the severity of liver damage in some cases. A liver biopsy involves removing a small sample of liver tissue using a needle, which is then examined under a microscope

How is MAFLD treated?

The treatment of MAFLD focuses on managing underlying risk factors and adopting lifestyle changes to improve liver health.

Most individuals diagnosed with MAFLD may not develop severe health issues, but it is good to take steps to prevent the condition from worsening. Making healthy lifestyle choices can help effectively improve your condition:

Adopting a healthy, balanced diet is crucial.
Regular physical activity is important. Aim for at least 150 minutes of moderate-intensity exercise, such as brisk walking or cycling, per week.
Maintaining good control of blood sugar levels through diet, exercise, and medications (if needed).
Keeping cholesterol and triglyceride levels within the normal range through diet, exercise, and medications (if prescribed).

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

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

Can fatty liver diseases be prevented?

You may potentially prevent fatty liver disease by maintaining regular physical activity, adopting a healthy diet, controlling your portion sizes, and keeping a healthy weight.

Make an appointment at Pantai Hospitals

Consult a doctor if you are experiencing symptoms of fatty liver disease. A dedicated and expert team of gastroenterology and hepatobiliary specialists at Pantai Hospitals is available for consultation to provide the best care and assistance.

Get in touch with us to book an appointment today if you have concerns or questions regarding MAFLD. We assure you the best possible care tailored to your specific needs.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.