Cases of fatty liver, also known as metabolic dysfunction-associated steatotic liver disease (MASLD), are increasingly being found in younger age groups, particularly those in their 30s.
dr Widya Khairunnisa Sarkowi, MSc, a lecturer at the Faculty of Medicine and Nutrition (FKGiz) at IPB University, explained that fatty liver occurs due to the accumulation of fat in the liver, which is linked to metabolic disorders.
According to her, this disease is often dubbed a silent killer because it develops slowly without showing clear clinical signs and can lead to permanent liver damage.
“Many people feel healthy, but when examined via ultrasound (USG) or liver enzyme tests, fatty liver is already detected. Individuals with obesity, diabetes mellitus, or other metabolic disorders are at higher risk of developing fatty liver,” she said.
Globally, the prevalence of fatty liver is estimated to be around 30 percent and continues to rise. Meanwhile, according to the 2023 Indonesian Health Survey (SKI), the prevalence of obesity among adults increased from 21,8 percent in 2018 to 23,4 percent in 2023. The prevalence of central obesity among people aged 15 and older reached 36,8 percent.
According to dr Widya, these high figures are a strong indicator of rising metabolic problems in the population, such as obesity, central obesity (or a protruding abdomen), diabetes, high cholesterol, hypertension, diets high in sugar and calories, and a lack of physical activity.
Nevertheless, she noted that fatty liver does not only affect people who are overweight. People of normal weight can still develop fatty liver if they have a protruding abdomen, insulin resistance, diabetes, a high-sugar diet, or a lack of physical activity.
dr Widya added that fatty liver is not merely a problem with the liver itself, but rather a marker of metabolic disorders throughout the body. Therefore, she urged the public not to be easily tempted by quick-fix solutions such as supplements, detox products, or herbal remedies that claim to “cleanse the liver.”
“Medication alone is not enough without accompanying lifestyle changes. Scientific evidence shows that lifestyle changes remain the most effective way to prevent and treat fatty liver,” she explained.
Five Preventive Steps
As a preventive measure, dr Widya shared five important educational messages in line with the recommendations of the World Health Organization (WHO). First, lose weight gradually. Losing about 5–10 percent of body weight is known to reduce liver fat, inflammation, and the risk of fibrosis.
Second, reduce consumption of sugary beverages such as sweetened tea, coffee with high sugar content, boba drinks, soda, packaged drinks, and syrups, which are sources of high-calorie liquid sugar. “The WHO recommends that free sugar intake be less than 10 percent of total daily energy needs, even below 5 percent ideally,” she said.
Third, adopt a balanced diet where half the plate consists of vegetables and fruits, one-quarter of protein, and one-quarter of carbohydrates. People are also advised to limit ultra-processed foods, fried foods, sugary foods, and high calorie snacks.
Fourth, engage in regular physical activity. The WHO recommends moderate-intensity physical activity for 150–300 minutes per week, or about 30 minutes a day, five times a week. Strength training twice a week is also recommended to increase muscle mass and insulin sensitivity.
Fifth, get regular screenings for risk factors, including measurements of waist circumference, body mass index (BMI), blood sugar levels, lipid profile, and blood pressure, as well as liver function tests and abdominal ultrasounds when necessary.
Early Education
Furthermore, dr Widya emphasized that fatty liver prevention should begin in childhood. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommends screening for fatty liver in obese children starting at ages 9–11, especially if they have additional risk factors such as insulin resistance, diabetes, dyslipidemia, or a family history of fatty liver.
“Children need to be encouraged to eat healthy foods, increase outdoor activities, reduce screen time, get enough sleep, and limit their consumption of sugary drinks and ultra-processed foods,” she said.
For adolescents, education should address modern lifestyle factors, such as the consumption of trendy beverages and fast food, staying up late, a sedentary lifestyle, and stress which can increase the risk of obesity and metabolic disorders.
Meanwhile, for young adults, it is recommended that they begin regularly monitoring their body weight, waist circumference, blood pressure, blood sugar, and lipid levels, especially if they have a family history of diabetes, obesity, or heart disease. For those over 40, early detection should be pursued more actively, as the risk of various metabolic diseases increases significantly.
dr Widya also cautioned the public against treating a diagnosis of “mild fatty liver” as normal. According to her, this condition can progress to liver inflammation, fibrosis, cirrhosis, and even liver cancer if not properly managed.
At the end of her remarks, dr Widya emphasized the importance of cross-sector collaboration. “Preventing fatty liver requires collaboration among all parties because it will be difficult for the public to adopt a healthy lifestyle if foods high in sugar and fat are more accessible, cheaper, and more heavily promoted than healthy alternatives,” she concluded. (dh) (IAAS/KQA)
