Hati berlemak (fatty liver) is a common condition where fat builds up in the liver, usually linked to being overweight, type 2 diabetes, high blood pressure or high cholesterol. It usually causes no symptoms and is often found by chance on a blood test or ultrasound. About 28% of adults in Malaysia were estimated to have it in a 2023 national survey. Most people only have the early stage, which can be reversed: losing 3% to 5% of your body weight can reduce liver fat, and cutting down on sugary drinks, refined carbohydrates and alcohol, together with regular exercise, helps protect the liver. A small number of people develop scarring, so regular check-ups matter.
Apa itu hati berlemak?
According to the NHS, non-alcoholic fatty liver disease is a common condition where fat builds up in your liver. It is often linked to being overweight and can usually be treated with healthy lifestyle changes.
You may also see it called MASLD (metabolic dysfunction-associated steatotic liver disease) or MAFLD. The newer names reflect that it is closely linked to metabolic health. European guidelines define it as fat in the liver together with at least one cardiometabolic risk factor, such as being overweight, type 2 diabetes, high blood pressure or abnormal blood fats, in someone who does not drink harmful amounts of alcohol.
How common is fatty liver in Malaysia?
Fatty liver is very common in Malaysia. In a nationwide survey of 1,011 adults by the Institute for Public Health (Ministry of Health) in 2023:
- an estimated 28.2% of adults had metabolic dysfunction-associated fatty liver disease, more than 1 in 4;
- men, people with abdominal obesity (a large waist), and people with higher blood pressure, blood sugar (HbA1c), triglycerides and liver enzymes were more likely to have it;
- Chinese adults had lower odds than Malay adults.
A related analysis of the same survey found that 35.9% of adults, about 8.5 million people, had metabolic syndrome, a group of risk factors closely linked to fatty liver. More than half (52.8%) had abdominal obesity.
Tanda hati berlemak
According to the NHS, fatty liver does not usually cause any symptoms. Many people have it without realising, and it is usually found when tests are done for another reason. Some people have:
- feeling very tired;
- feeling generally unwell;
- pain or discomfort in the upper right side of the tummy, under the ribs.
Because there are often no warning signs, it is worth asking your doctor about your liver if you have any of the risk factors below.
Punca & who is at risk
According to the NHS, you are more likely to get fatty liver if you:
- are overweight, particularly if you have a lot of fat around your stomach and waist (see how to lose belly fat);
- do not have a healthy diet or are not very physically active;
- have type 2 diabetes (see kencing manis);
- have polycystic ovary syndrome (PCOS);
- have high blood pressure or high cholesterol (see darah tinggi and kolesterol tinggi);
- are over 50.
Drinking too much alcohol can cause a different condition, alcohol-related liver disease. When diagnosing fatty liver, your doctor will ask how much alcohol you drink to tell the two apart.
Fatty liver in women
In the Malaysian survey, men were more likely than women to have fatty liver, but women can still be affected. The NHS lists PCOS as a risk factor, and the risk rises after 50. A large waist is a key risk factor in both the NHS list and the Malaysian survey. If you have PCOS, have had diabetes or high blood pressure, or have gained weight around your waist, ask your doctor whether your liver should be checked. See our guide to PCOS for more.
The 4 stages of fatty liver
According to the NHS, fatty liver has 4 stages. Most people only have the first stage, and lifestyle changes can help stop it getting worse.
| Stage | What it means (NHS) |
|---|---|
| 1. Fatty liver (steatosis) | Fat builds up in the liver, but there is no damage |
| 2. Steatohepatitis (MASH, previously NASH) | The fat has caused inflammation in the liver; not yet seriously damaged, but it could get worse |
| 3. Fibrosis | There is scarring in the liver, but it is usually still working well |
| 4. Cirrhosis | Severe damage that affects how the liver works, which can lead to internal bleeding, liver failure or liver cancer |
How fatty liver is diagnosed
According to the NHS, fatty liver is usually found after blood tests or scans done for another reason show signs of liver problems. Your doctor will ask about your symptoms and how much alcohol you drink, and check your weight and waist. They may arrange:
- blood tests, including liver function tests;
- an ultrasound scan of the tummy to look for fat in the liver;
- tests to check for liver scarring. European guidelines recommend a step-by-step approach, starting with a blood-based score called FIB-4 and, if needed, a special liver scan called transient elastography (often known as a FibroScan).
Cara merawat hati berlemak
For most people, treatment is about lifestyle changes. The NHS says these can reduce the fat in your liver and help repair damage or stop it getting worse.
| Step | What helps |
|---|---|
| Lose weight gradually | Losing at least 3% to 5% of your body weight can reduce liver fat; 7% to 10% may be needed to reduce inflammation and scarring (NIDDK). Avoid crash diets, as rapid weight loss can make liver disease worse |
| Exercise regularly | Aim for at least 150 minutes a week (NHS). Physical activity helps even if you do not lose weight (NIDDK) |
| Eat a healthy, balanced diet | Fewer sugary drinks and refined carbohydrates, more vegetables, fruit and whole grains (see below) |
| Cut down on alcohol and stop smoking | Alcohol can further damage the liver (NIDDK); the NHS also advises not smoking |
| Manage related conditions | Keep blood sugar, blood pressure and cholesterol under control |
For practical steps, see our safe weight loss guide.
Medical treatment: if there is liver damage (fibrosis or cirrhosis), you will need to see a liver specialist. According to the NHS, treatment may include a medicine called pioglitazone or vitamin E, prescribed by the specialist. European guidelines (2024) also mention weight-loss and diabetes medicines such as semaglutide or tirzepatide for people with type 2 diabetes or obesity where suitable, a liver-targeted medicine called resmetirom where it is approved, and weight-loss surgery for some people with obesity. These are decided by a doctor; do not start them on your own.
Pantang larang: foods and drinks to limit
According to the NIDDK, your doctor may suggest these changes:
- Avoid foods and drinks high in simple sugars, especially fructose, found in sweetened soft drinks, sports drinks, sweetened tea and juices. Table sugar is also a major source of fructose. (See the best and worst Malaysian drinks.)
- Choose low glycaemic index foods, such as most vegetables, fruits and whole grains, instead of high glycaemic index foods such as white bread, white rice and potatoes.
- Limit fatty, high-calorie foods, and replace saturated and trans fats with unsaturated fats, especially omega-3 fats.
- Minimise alcohol.
In everyday Malaysian eating, this could mean asking for drinks kurang manis or kosong, swapping some white rice for brown rice or more vegetables, and choosing steamed or grilled dishes more often than deep-fried ones.
Be careful with herbal remedies and supplements
The NIDDK advises talking to your doctor before taking dietary supplements, vitamins or any complementary or alternative remedies, because some herbal remedies can damage the liver. Tell your doctor about anything you take, including traditional remedies.
Fatty liver, your heart and other conditions
Fatty liver is not only about the liver. The Malaysian Society of Gastroenterology and Hepatology notes that cardiovascular disease is the leading cause of death in people with fatty liver, so checking and managing your heart risk is an important part of care. The NHS adds that the same lifestyle changes reduce the risk of conditions linked to fatty liver, including heart disease, chronic kidney disease, high blood pressure and type 2 diabetes.
Check-ups and when to see a doctor
According to the NHS, if you have fatty liver you should have check-ups at least once a year, and tests every 2 to 3 years to monitor your condition. See a doctor if:
- you think you could have fatty liver, or have a higher risk of getting it;
- a blood test or scan has shown fat in your liver or abnormal liver results;
- you have type 2 diabetes, PCOS, high blood pressure or a large waist and have never had your liver checked.
Get medical help promptly if you notice yellow skin or whites of the eyes, a swollen tummy or legs, vomiting blood, or very dark or black poo. The NHS lists these among the symptoms of cirrhosis, the most serious stage of liver damage; see the NHS guide to cirrhosis in the references.
Frequently asked questions (FAQ)
Apa punca hati berlemak (what causes fatty liver)?
Fatty liver happens when fat builds up in the liver. According to the NHS, you are more likely to get it if you are overweight, especially with a lot of fat around your waist, eat an unhealthy diet or are not very active, or have type 2 diabetes, polycystic ovary syndrome (PCOS), high blood pressure or high cholesterol, or are over 50. Drinking too much alcohol can also cause a separate type called alcohol-related fatty liver.
Apakah tanda hati berlemak (what are the signs)?
Fatty liver usually causes no symptoms, and many people only find out when blood tests or scans are done for another reason, according to the NHS. Some people feel very tired or generally unwell, or have discomfort in the upper right side of the tummy, under the ribs.
Can fatty liver be reversed (boleh sembuh tak)?
In many cases, yes. The NHS says healthy lifestyle changes can reduce the build-up of fat in the liver and help repair damage or stop it getting worse. According to the NIDDK, losing at least 3% to 5% of your body weight can reduce liver fat, and losing 7% to 10% may be needed to reduce inflammation and scarring.
Apa pantang larang hati berlemak (what should I avoid)?
According to the NIDDK, limit foods and drinks high in simple sugars, especially sweetened soft drinks, sports drinks, sweetened tea and juices; cut down on high-calorie fatty foods and replace saturated and trans fats with unsaturated fats; choose low glycaemic index foods such as most vegetables, fruits and whole grains over white rice and white bread; and minimise alcohol. The NHS also advises not smoking.
How much weight do I need to lose?
The NIDDK says losing at least 3% to 5% of your body weight can reduce fat in the liver, and you may need to lose 7% to 10% to reduce inflammation and fibrosis. For someone who weighs 80 kg, that is about 2.4 to 4 kg, and 5.6 to 8 kg. Lose weight gradually, as rapid weight loss and malnutrition can make liver disease worse. Physical activity helps even without weight loss.
Is fatty liver dangerous?
Most people only have the first stage, simple fatty liver, which does not usually cause problems, according to the NHS. A small number go on to develop inflammation, scarring (fibrosis) and cirrhosis, which can lead to liver failure or liver cancer. The Malaysian Society of Gastroenterology and Hepatology notes that heart and blood vessel disease is the leading cause of death in people with fatty liver, so managing blood pressure, cholesterol and blood sugar matters too.
Can slim people get fatty liver?
Yes. Under current European guidelines, this type of fatty liver is defined as fat in the liver plus at least one cardiometabolic risk factor, such as being overweight, type 2 diabetes, high blood pressure or abnormal blood fats. This means a person with a normal weight can still have fatty liver if they have other metabolic risks, such as diabetes.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. Do not start or stop any medicine without medical advice. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Non-alcoholic fatty liver disease (NAFLD) — NHS
- Treatment for NAFLD and NASH — NIDDK
- Eating, diet and nutrition for NAFLD and NASH — NIDDK
- EASL-EASD-EASO Clinical Practice Guidelines on the management of MASLD: Executive Summary. Diabetologia. 2024;67(11):2375-2392
- Wan KS, et al. Prevalence and factors associated with metabolic dysfunction-associated fatty liver disease in a multiethnic Asian country. Sci Rep. 2026;16(1):1922
- Wan KS, et al. The prevalence of metabolic syndrome and the associated factors in a multiethnic upper-middle-income country in Asia: findings from a nationwide community-based study in 2023. BMC Public Health. 2025;25(1):1482
- Cirrhosis — NHS
- Chan WK, et al. Malaysian Society of Gastroenterology and Hepatology consensus statement on metabolic dysfunction-associated fatty liver disease. J Gastroenterol Hepatol. 2022;37(5):795-811
