Minh did not smoke or drink alcohol, and had a BMI of 24,3 (overweight by Asian standards). He visited Tam Anh General Hospital TP HCM for a pre-marital health check-up. Blood tests revealed his liver enzymes were three times higher than normal (typically below 40 U/L), and his average blood sugar over three months, HbA1c, was 5,8 mmol/L, indicating pre-diabetes.

Doctor Nguyen Ho Thanh Tung, from the General Internal Medicine Department, ordered a liver elastography to measure the degree of fibrosis and an MRI to quantify liver fat percentage. Results confirmed Minh had metabolic-associated fatty liver disease, with fat accounting for over 30% of his liver volume — six times the safe level. The disease had progressed to significant fibrosis (F2).

Non-alcoholic fatty liver disease is characterized by excess fat accumulation in liver cells, exceeding 5% of the liver's weight. At stage F2, prolonged inflammation of liver cells due to fat leads to elevated liver enzymes and the formation of widespread fibrous scar tissue, causing the liver parenchyma to gradually lose elasticity and begin to harden.

According to Doctor Tung, F2 remains a "golden window" for treatment, as liver cells at this stage still have the capacity to recover if properly managed with medical treatment and lifestyle changes.

Minh and his fiancee visited for a pre-marital general health check-up. Photo: Tam Anh General Hospital

Fatty liver disease can stem from various causes, including alcohol consumption, diets high in refined carbohydrates, obesity, sedentary lifestyles, and excessive consumption of sweets, which lead to excess energy accumulating in the liver as fat.

Minh was prescribed medications to help lower liver enzymes and antioxidants to protect liver cells and prevent inflammatory responses, alongside drugs to control metabolic disorders. Concurrently, the doctor advised him to cut down on sugar, limit processed foods, increase fiber intake, and maintain a minimum of 150 minutes of exercise per week.

After three weeks, Minh's follow-up appointment showed he had lost 3 kg, his waist circumference had decreased, liver enzyme levels had normalized to 40 U/L, fatty liver disease had reduced to 18%, and liver elasticity reached 6,8 kPa (improving from F2 fibrosis to F1). He continues medical treatment, weight loss, and lifestyle changes to bring his liver fat index below 5%.

Thao Vy

*Patient's name has been changed