The silent conditions men miss: raised cholesterol, prediabetes and fatty liver

Men are less likely than women to see a doctor when they feel well. That is understandable, but it means some of the most common conditions in men are found late. Raised cholesterol, prediabetes and fatty liver have three things in common: they are widespread, they feel like nothing, and a blood test can pick them up early.

They also tend to travel together. A man with one of them often has another, and all three raise the risk of heart disease.

Raised cholesterol

Cholesterol builds up in the walls of the arteries slowly, over decades. There is no pain and no warning sign. For many people, the first symptom of high cholesterol is a heart attack or stroke.

The number that matters most is LDL cholesterol. LifePrint follows the SA Heart and Lipid and Atherosclerosis Society of Southern Africa 2018 guideline, which sets a target below 3.0 mmol/L for people at low to moderate risk. A result of 3.0 to 3.4 mmol/L sits in LifePrint's grey zone. Higher results are graded, and very high levels at a young age can point to an inherited condition called familial hypercholesterolaemia, which is common in some South African communities and runs in families.

Triglycerides above 1.7 mmol/L and an HDL cholesterol below 1.0 mmol/L in men add to the picture, and often point to the other two conditions below.

Prediabetes

Prediabetes means blood sugar is higher than normal but not yet in the diabetes range. It usually causes no symptoms at all. Many people with prediabetes have no idea, and some are only diagnosed when diabetes has already developed.

Following SEMDSA 2017, prediabetes shows up as an HbA1c of 6.0 to 6.4% or a fasting glucose of 6.1 to 6.9 mmol/L. Both are shown in LifePrint's grey zone. Found at this stage, it can often be slowed or reversed through changes to activity, eating and weight. Our Diabetes Check articles explain these numbers in more depth.

Fatty liver

Fatty liver means extra fat stored in the liver cells. The most common form is linked to excess weight, insulin resistance and high blood fats rather than alcohol, and it is now called metabolic dysfunction-associated steatotic liver disease, or MASLD. Alcohol can cause fatty liver too, and the two often overlap.

In most people, fatty liver stays mild. In some, it slowly causes inflammation and scarring over years, which can eventually lead to cirrhosis. It is also strongly linked with heart disease and type 2 diabetes.

On a blood test, fatty liver often shows up as a mildly raised ALT or GGT. LifePrint uses the American College of Gastroenterology 2017 limit for ALT of 33 U/L in men. Results up to twice that limit sit in a grey zone and should be repeated before investigation.

Why these three travel together

At the root of all three is often insulin resistance, where the body needs more and more insulin to control blood sugar. It pushes the liver to make more fat, raises triglycerides, lowers HDL and slowly raises blood sugar. Weight carried around the waist is both a cause and a sign of this process.

That is why reading the markers together is so useful. A pattern such as high triglycerides, low HDL, a borderline HbA1c and a mildly raised ALT tells a clear story, even when no single result is dramatic.

What can be done

The encouraging part is that the same steps help all three. Regular activity, modest weight loss if you are carrying extra weight, less alcohol, fewer sugary drinks and refined starches, more fibre, and not smoking all improve cholesterol, blood sugar and liver fat together. Some people will also need medication, particularly for cholesterol, and that is a decision to make with a doctor who knows your overall risk.

What to do next

If you have not had a blood test in the last year or two, the Well Man panel covers all of these markers. Your LifePrint report flags results outside the range, shows grey zone results separately, and tells you how urgently to follow up. If any of these markers are flagged, especially more than one, discuss them with a registered healthcare practitioner. This is health information, not a diagnosis.