What Is Fatty Liver Disease? A Singapore Guide (2026)

What Is Non-Alcoholic Fatty Liver Disease (NAFLD)?

Non-Alcoholic Fatty Liver Disease (NAFLD) is a condition where excess fat builds up in the liver cells of people who drink little or no alcohol. It is the most common chronic liver disease worldwide and encompasses a spectrum from simple fatty liver (steatosis) to non-alcoholic steatohepatitis (NASH), which involves inflammation and can lead to fibrosis, cirrhosis, and liver failure.

According to the American Association for the Study of Liver Diseases (AASLD), NAFLD affects approximately 25-30% of the global population. In Asia-Pacific regions, prevalence rates are rising rapidly due to urbanization and dietary changes.

How Common Is Fatty Liver in Singapore?

Singapore has one of the highest NAFLD prevalence rates in the Asia-Pacific region. Research published in the Journal of Hepatology estimates that approximately 40% of Singapore adults have some degree of fatty liver disease.

Key statistics for Singapore:

• 40% prevalence among the general adult population — according to a 2019 study published in the Singapore Medical Journal (Goh et al., 2019), the estimated prevalence of NAFLD in Singapore is between 25-40%, varying by ethnic group.
• Higher than the global average of 25-30% (Younossi et al., "Global epidemiology of NAFLD," Hepatology, 2016).
• Ethnic variation: Indian Singaporeans have the highest prevalence, followed by Malay and Chinese populations — as reported in the Singapore Epidemiology of Eye Diseases (SEED) study linked liver fat assessments.

Source: Goh GBB, et al. "Non-alcoholic fatty liver disease in Asians." Journal of Gastroenterology and Hepatology, 2019.

What Causes Fatty Liver?

The primary drivers of NAFLD include:

1. Insulin resistance and metabolic syndrome — the most significant risk factor, as documented in the EASL-EASD-EASO Clinical Practice Guidelines for NAFLD (Journal of Hepatology, 2016).
2. Obesity (BMI > 25) — approximately 70-80% of individuals with obesity have NAFLD (Chalasani et al., Hepatology, 2018).
3. Diet high in fructose and refined carbohydrates — a meta-analysis in Alimentary Pharmacology & Therapeutics (2017) found that high fructose consumption significantly increases liver fat.
4. Sedentary lifestyle — physical inactivity is independently associated with NAFLD progression.

Singapore-Specific Risk Factors

Singapore's food culture presents unique challenges:

• High sugar beverages: Teh tarik, kopi with condensed milk, bubble tea, and sweetened fruit juices are staples. The Health Promotion Board (HPB) Singapore reports that Singaporeans consume an average of 60g of sugar daily, well above the WHO recommendation of 25g.
• Hawker centre dining: While convenient and affordable, many popular hawker dishes are high in refined carbohydrates and saturated fats.
• Rising ultra-processed food consumption: Singapore's processed food market has grown significantly, contributing to metabolic risk.

Symptoms — The Silent Disease

NAFLD is often called the "silent disease" because most people experience no symptoms in the early stages. This is confirmed by the AASLD Practice Guidance on NAFLD (Rinella et al., Hepatology, 2023).

When symptoms do appear, they may include:

• Fatigue and low energy
• Discomfort in the upper right abdomen
• Unexplained weight gain
• Brain fog

When to see a doctor: If you have risk factors (BMI > 25, diabetes, high cholesterol) or if routine blood tests show elevated liver enzymes (ALT, AST), consult a hepatologist or gastroenterologist.

How Is Fatty Liver Diagnosed?

Common diagnostic methods used in Singapore:

1. Ultrasound — the most common first-line screening tool (recommended by EASL guidelines)
2. FibroScan (Transient Elastography) — measures liver stiffness to assess fibrosis stage. Available at SGH, NUH, TTSH, and most restructured hospitals
3. Blood tests — ALT, AST, GGT levels; FIB-4 index for fibrosis assessment
4. Annual health screening — the Ministry of Health (MOH) Singapore recommends regular health screenings for adults aged 40+

The 4 Stages of Fatty Liver Disease

| Stage | Name | Reversible? | Description | |-------|------|-------------|-------------| | 1 | Simple Steatosis | Yes | Fat accumulation without inflammation | | 2 | NASH | Partially | Fat + inflammation + liver cell damage | | 3 | Fibrosis | Difficult | Scarring of liver tissue begins | | 4 | Cirrhosis | No | Permanent scarring, liver function impaired |

Source: Chalasani N, et al. "The diagnosis and management of NAFLD: Practice guidance from AASLD." Hepatology, 2018.

Can Fatty Liver Be Reversed?

Yes — Stage 1 and early Stage 2 fatty liver is completely reversible through lifestyle changes, primarily diet and exercise.

Research evidence:

• A study in Gastroenterology (Vilar-Gomez et al., 2015) found that 10% body weight loss resolved NASH in 90% of patients and fibrosis in 45%.
• The Mediterranean diet has been shown to reduce liver fat by 25-30% in 12 weeks (Journal of Hepatology, Gepner et al., 2019).
• 150 minutes of moderate exercise per week significantly reduces liver fat, even without weight loss (Keating et al., Journal of Hepatology, 2012).

The key intervention is daily dietary management — not just occasional changes, but consistent, informed food choices every day.

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