Ask The Experts

Living with fatty liver disease

Good quality of life possible with regular follow-up checks and lifestyle modifications

I have a fatty liver and was recently diagnosed with liver cirrhosis (hardening or scarring of the liver).

I would like to know more about liver problems such as the risk of getting cirrhosis from a fatty liver, and the different stages and classifications of liver cirrhosis, liver failure and liver cancer.

My doctor said there are no treatments or medicines to deal with cirrhosis. It is also hard to predict the progress of the condition and the risk of getting either liver failure or liver cancer.

How can I live with this? What can a cirrhosis patient do in order to live on and plan for his future?Am I at risk of developing many complications because of my cirrhosis? What are some of the worst complications I can avoid?

I also have backache, emanating from the centre of my back next to the spine.

Is that related to my liver issue? I already have diabetes and other issues such as hypertension.

Is a biopsy needed to test whether a liver tumour is cancerous? Or can the cancer be detected via blood tests or computed tomography (CT) or magnetic resonance imaging (MRI) scans?

Fructose (fruit sugar) consumption, commonly found in soft drinks and sweets, should be limited as it is associated with Nash and cirrhosis.

Coffee, on the other hand, is associated with decreased risk of liver disease and reduced fibrosis in patients with chronic liver disease.

Besides fatty liver disease, other chronic liver diseases, such as viral hepatitis B and C, and autoimmune liver disease, can also lead to liver cirrhosis.

Fatty liver disease can be a result of excessive alcohol consumption or as a manifestation of metabolic syndrome, which is a combination of several diseases such as diabetes mellitus, hypertension, abdominal obesity and dyslipidemia (for example, high total cholesterol levels or high levels of triglycerides).

As you mentioned that you have diabetes and hypertension, it is more likely in your case that you have non-alcoholic fatty liver disease (NAFLD).


NAFLD represents a clinical spectrum of diseases, ranging from the relatively benign simple accumulation of fat to the more aggressive condition with inflammatory damage or Non-Alcoholic SteatoHepatitis (Nash).

The latter can potentially lead to liver cirrhosis where the liver is permanently damaged or scarred and no longer able to work properly.

About 25 per cent to 30 per cent of patients with Nash develop liver cirrhosis, with risk factors including being older, presence of diabetes mellitus and other metabolic syndrome risk factors.

The progression of Nash to cirrhosis is often slow, insidious and difficult to detect, especially since most patients are asymptomatic until the advanced stages of cirrhosis.

Liver cirrhosis is often classified according to the Childs Pugh grading, based on five clinical measures of liver dysfunction.

Grade A indicates early cirrhosis while grade C indicates advanced-stage or end-stage liver cirrhosis. Once liver cirrhosis develops, the risk of liver-related complications also increases.

Complications include fluid retention, gastrointestinal bleeding, mental changes, impaired immunity, easy bruising, kidney failure and liver cancer.

The natural history of Nash-related cirrhosis and rates of progression to liver complications are variable.

Nevertheless, many patients with liver cirrhosis can maintain a relatively good quality of life.

With the onset of cirrhosis, it is important to have regular follow-up checks with your doctor to monitor for development of liver-related complications or deterioration of your liver function.

This may include regular blood tests to assess liver function, liver imaging such as ultrasound or CT scan and endoscopy to evaluate risk of bleeding.

Some doctors recommend endoscopy for patients newly diagnosed with mild to moderate cirrhosis in order to screen for enlarged veins in the oesophagus that increase the risk for bleeding.

In this test, a fibre-optic tube is inserted down the throat. The tube contains tiny cameras to view the inside of the oesophagus, where the enlarged veins are most likely to develop. Early treatment of complications may help to ameliorate outcomes considerably.

While there are no current treatments to cure cirrhosis, efforts can be made to minimise progression of the underlying Nash.

Lifestyle modifications remain the cornerstone of first-line recommendations.

These include weight reduction of 7 per cent or more if the person is obese or overweight, avoidance of alcohol and more physical activity.

Current recommendations suggest at least 150 minutes of moderate to vigorous physical activity per week.

Along similar lines, the Mediterranean-type diet, with a high consumption of fruit, vegetables, legumes and complex carbohydrates, moderate consumption of fish, poultry, olive oil and low consumption of full-fat dairies and red meat, has also been shown to be beneficial.

Fructose (fruit sugar) consumption, commonly found in soft drinks and sweets, should be limited as it is associated with Nash and cirrhosis.

Coffee, on the other hand, is associated with decreased risk of liver disease and reduced fibrosis in patients with chronic liver disease.

Concurrent diseases, such as diabetes, hypertension, dyslipidaemia, gout and obstructive sleep apnoea, should also be well controlled.

Certain drugs for treating Nash can be explored, but this should be done only in collaboration with your doctor.

In addition, immunisation against hepatitis A and B are recommended in all patients with non-hepatitis B-related cirrhosis if they are not already immunised.

It is unlikely that your backache is related to your liver disease.


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On the other hand, in some patients with advanced cirrhosis, significant fluid retention in the abdomen may put a strain on the back, leading to backache.

Likewise, if you have abdominal obesity, that may also work along similar lines, leading to backache.

However, you should consult your doctor to clarify and further investigate the cause of your backache.

In many cases, liver cancer can usually be detected via CT or MRI scans if the cancer has certain defining characteristics on the scans.

The current practice is to proceed with treatment of the liver cancer without the need for biopsy of the tumour.

However, if there are some doubts about the diagnosis, a targeted liver biopsy may help to guide the management of the tumour.

A version of this article appeared in the print edition of The Straits Times on March 01, 2016, with the headline 'Living with fatty liver disease'. Print Edition | Subscribe