There are 2 main causes of fatty liver disease:

• Alcoholic fatty liver disease: Severity varies according to the type, quantity, and length of alcohol consumption.
• Non-alcoholic fatty liver disease: It is usually associated with metabolic syndromes, such as obesity, diabetes, high blood pressure, high cholesterol, and hepatitis C virus.

One of the primary functions of the liver is to store energy. Excessive consumption of certain food types causes fat to build up in the liver. Excess fat then accumulates in the liver cells. Obesity, diabetes, high cholesterol, excessive alcohol consumption, rapid weight loss, and malnutrition are contributing factors to fatty liver disease. However, some patients develop fatty liver disease without any of these conditions.

• Obesity: Around 20% of obese people have fatty liver disease.
• Excessive weight: People with a body mass index (BMI) of between 25-30 are at risk
• Diabetes
• Excessive alcohol consumption
• Ultra-sweet foods: Consumption of excessively sweet foods and beverages, such as sweet green tea, is a risk factor

There are 4 different stages of fatty liver disease as follows:

• Stage 1: The fat builds up in the liver without any inflammation or scarring.
• Stage 2: The build-up of fat causes inflammation. If the inflammation persists and remains untreated for more than 6 months, chronic liver inflammation will develop.
• Stage 3: Severe liver inflammation and scarring occur. The liver cells are slowly destroyed. 
• Stage 4: Serious damage to the liver cells causes liver function abnormalities, leading to cirrhosis and ultimately liver cancer.

Generally, fatty liver disease causes no noticeable signs and symptoms. Even when symptoms such as fatigue, nausea and pain in the upper right abdomen are observed, they are usually not associated with fatty liver disease. Most patients only discover that they have the fatty liver disease during an annual health check-up or medical examination for other reasons.

• Blood tests
• Ultrasound
• Magnetic resonance imaging (MRI)
• Biopsy (removing a sample of liver tissue for testing)

• Lose weight if you are overweight or obese. The ideal rate of weight loss is 0.25-0.5 kg per week until you reach a healthy weight.
• Exercise regularly, at least 5 days a week. If possible, aerobic and anaerobic exercise is recommended, such as fast walking followed by low impact weight lifting.
• Choose a healthy diet by eating low-fat, high-fibre, and low-energy food.
• Manage diabetes and high cholesterol. Take medications as directed. Control your diet and exercise regularly. 
• Avoid non-prescription medications and food supplements.
• Avoid alcohol consumption.
• Have a regular health check-up.