Non-alcoholic fatty liver disease (NAFLD) is a major cause of liver disease worldwide with an estimated global prevalence among the general population of 25% and 27% in Asia. The prevalence of NAFLD among in the general Malaysian population is 23%, but around 49.6% among diabetic population and much higher (up to 90%) in obese patients. NAFLD also affects children and adolescents in tandem with the growing obesity epidemic. The prevalence of NAFLD in children is reported to be around 7.6% to 34.2%.

NAFLD encompasses a spectrum of manifestations from non-alcoholic fatty liver (NAFL), which is characterized by liver steatosis (excessive fat accumulation in the liver) , non-alcoholic steatohepatitis (NASH, characterized by inflammation and liver scarring or fibrosis, to cirrhosis (replacement of the entire liver with scar formation) and its complications, including liver cancer .

Obesity and metabolic syndrome are closely related to NAFLD. Metabolic syndrome describes a constellation of cardiovascular risk factors such as central adiposity, impaired glucose metabolism, hypertension and dyslipidaemia. Cardiovascular disease is the commonest cause of death in patients with NAFLD, followed by malignancy and liver-related complications. The increasing morbidity and mortality related to NAFLD can be attributed to the dramatic escalation in the prevalence of obesity and metabolic syndrome globally.


Fatty liver or non-alcoholic fatty liver disease (NAFLD) is characterised by the accumulation of fat in the liver that is not caused by excess alcohol consumption.

Fatty liver/NAFLD is now the commonest liver disease worldwide and it’s mainly caused by being above a healthy weight, diabetes and “over-nutrition”.

Accumulation of fat in the liver can lead to inflammation or “hepatitis”, liver scarring or “fibrosis”, and eventually, cirrhosis (the whole liver is replaced by scar tissue), liver failure and cancer.


A leading preventable risk factor for cancer is "being above a healthy weight"

The risk of being above a healthy weight poses to health is dependent upon where that excess weight or body fat is stored.

Excess body fat around the waistline identifies individuals at increased risk of accumulation of toxic or visceral fat in vital organs such as the liver, which is associated with adverse health consequences, including cancer.

To overcome the pitfalls of BMI, the waistline measurement is used to better represent the distribution of the fat in the body.

Our waistline measurement is a better indication of fat distribution

A healthy waist size should be

  • - less than 90cm for men,
  • - less than 80cm for women

EASL algorithm for non-invasive assessment

Risk stratification: assessment of liver fibrosis

Source: *Estimated prevalence for low-, intermediate- and high-risk groups
Vilar-Gomez E, Chalasani N. J Hepatol 2018;68:305-15