Fatty liver in Singapore: what the scan and the bloods show
Fatty liver affects roughly one in three adults. Most have no symptoms, and in Asian populations it appears at weights that look perfectly normal.
What fatty liver is
Fat builds up inside liver cells. Past about five percent of liver weight, it is called fatty liver. Most people who have it feel completely well.
It is usually found by accident. A scan ordered for something else, or a liver enzyme slightly raised on a routine panel.
Around one in three adults worldwide has it. Across Asia the figure is comparable, and in some regional studies higher.
When a normal BMI misleads
This is the part most people get wrong. It matters more here than almost anywhere.
Fatty liver appears at lower body weights in Asian populations than in Western ones. Singapore recognises this: the threshold where risk climbs is a BMI of 23, not 25.
Waist measurement is often the better signal. It reflects where the fat sits, not just how much there is. Above 90cm for men or 80cm for women is where metabolic risk climbs.
The name changed in 2023. International groups renamed it metabolic dysfunction associated steatotic liver disease, or MASLD. Your report may still say NAFLD or fatty liver. They describe the same thing.
What the blood tests show
No single blood test confirms fatty liver. Several markers move together, and the pattern is what matters.
| Marker | What it shows |
|---|---|
| ALT and AST | Liver enzymes. In fatty liver, ALT is usually the higher of the two. Both can sit inside the normal range even when fat is present. |
| GGT | Rises with liver fat, alcohol and several common medications. Useful alongside the others, misleading on its own. |
| Triglycerides and HDL | High triglycerides with low HDL is the metabolic pattern that usually travels with fatty liver. |
| HbA1c and fasting insulin | Insulin resistance drives most cases. Insulin often rises years before glucose does, so fasting insulin is worth measuring. |
A normal ALT does not exclude fatty liver. Reference ranges for liver enzymes were set decades ago, from populations that included people with undiagnosed liver disease.
What the scan shows
Ultrasound is the usual first look (yet it can miss mild steatosis). It detects fat reliably once a reasonable amount is present. It is quick and involves no radiation.
What it cannot tell you is whether the liver is scarred. That distinction is the one that matters most.
Fat alone is largely reversible. Fibrosis, the scarring that can follow years of inflammation, is much harder to undo. A small minority progress to significant fibrosis, and those people need closer follow up.
A FibroScan measures liver stiffness directly. A calculated score such as FIB-4 uses age, platelet count, ALT and AST. It estimates risk without any extra test. If you have fatty liver, ask which of these has been done.
With hepatitis B
Chronic hepatitis B is common across this region. It is far less common in Europe or North America, and a significant number of people carrying it do not know.
Fatty liver on top of chronic hepatitis B is a different situation clinically. The two conditions act on the same organ, and the combination is followed more closely than either alone. Monitoring intervals are usually shorter, and the threshold for imaging is lower.
Say you have fatty liver but have never had your hepatitis B status checked. That is worth doing once. If you already know you are a carrier, tell whoever is managing your liver results.
What actually changes it
Fatty liver responds to remarkably few things, but it responds well.
There is now one medication approved specifically for the more advanced form. GLP-1 medicines used for weight and diabetes also reduce liver fat. Neither is a first step. Both are conversations to have with a doctor who has seen your full picture.
If your ALT is raised
A single raised reading is not enough. Most doctors will repeat the test before acting, because enzymes move with recent alcohol, exercise, illness and several common medications.
Ultrasound is usually the next step. It is available at polyclinics on referral and at private clinics directly.
FibroScan is not routine. It is available privately and in hospital hepatology clinics. If your enzymes stay raised, ask whether it is warranted.
What to ask for
If your ALT or GGT has been flagged more than once, ask whether an ultrasound is warranted.
If you have been told you have fatty liver, ask for a FIB-4 score. It costs nothing extra and answers the question that matters.
Ask for fasting insulin alongside HbA1c. It moves earlier.
Retest after six months of real change rather than after six weeks.
What we published, what we read, and the one thing worth changing. Nothing to buy.
Insulin moves years before glucose does.
The Core Health Test measures 100+ markers, with a doctor to walk you through what each one means for you.
metabolic markers in the Core Health Test