Study shows incidents of non-alcoholic fatty liver disease here is rising and half of adults may be affected

Last month, news of Deputy Speaker of Parliament Charles Chong undergoing a liver transplant took many people by surprise.

Three years ago, the MP for Punggol East, 63, was diagnosed with a severe form of non-alcoholic fatty liver disease (NAFLD) steatohepatitis but did not make it public.

While NAFLD is an unfamiliar term to most people, a recently released study by SingHealth doctors found that its incidence is rising in Singapore, and could well be affecting half of the adults here.

This could put more people at risk of liver failure or cancer, the main causes of which are hepatitis or heavy alcohol use.

But the damage caused by NAFLD is similar.

Professor Pierce Chow, the lead doctor in the study, said it suggested the rate here could be higher than the Asian average of about 30 per cent of adults.

While the causes of the disease are not clear, people with NAFLD tend to have hypertension and high cholesterol levels – the same risks for heart disease, diabetes and obesity.

The study looked at Singapore General Hospital patients who had surgery to remove their gall bladder, an organ next to the liver, for the periods 2001 to 2004 and 2011 to 2014.

GROUP

From the pre-operative scans of the earlier group of 127 patients, 40 per cent had NAFLD. Ten years later, 57 per cent of 99 patients had it.

More patients in the later group also had high levels of cholesterol – 46 per cent versus 19 per cent. 
Almost half of the patients in both groups had high blood pressure.

The study, published online on Dec 20 prior to printing by the Singapore Medical Journal, said it was “a significant increase” and intervention is needed to prevent NAFLD’s progression to more advanced liver disease such as liver cirrhosis (hardening) and hepatocellular carcinoma (liver cancer).

Prof Chow said fatty liver disease is a growing concern in many developed countries that face rising obesity. In the US, NAFLD is the third most common cause of liver cancer after hepatitis and alcoholic liver disease.

As it has no symptoms, NAFLD is rarely discovered until much damage has been done. Researchers also found that the more obese the person, the higher the risk of having a fatty liver. Indians also appear to be at higher risk.

According to the National University Hospital, which carries out the bulk of liver transplants here, “common causes of liver failure include hepatitis B, cirrhosis, cancer and autoimmune disease”.

There are about 60 people waiting for a liver transplant, about five times the number 10 years ago. Last year, 38 people had liver transplants.

This article was first published on Dec 3, 2016.
Get a copy of The Straits Times or go to straitstimes.com for more stories.

Singapore

2016 was a heartening year for startups, which were propelled into the limelight for driving record venture capital (VC) investments in Singapore, being recognised as vehicles for disruption and innovation, and invoking concerns about their sustainability and burn rates.

Tech startups, in particular, led the Republic’s US$3.5 billion (S$5 billion) worth of private equity and VC investments in 2016, its best showing in the last five years based on a Duff and Phelps report. Among the most notable investments were Alibaba’s US$1-billion acquisition of a controlling stake in Lazada, and Softbank’s US$750-million investment in Grab.

It was, in fact, a banner year for local VC firm Wavemaker, in terms of exits by its portfolio startups. Pie, a chat app, was acquired by Google for an undisclosed sum. Mobile advertising firm ArtofClick was snagged by Philippines-based firm Xurpas for US$45 million. Cosmetics e-commerce site Luxola’s buyout by LVMH won VC Exit of the Year, an award handed out in October by the Singapore Venture Capital and Private Equity Association (SVCA).

There were also acquisitions by local startups of global big-names, which turned the world’s gaze on Singapore. These included gaming company Razer’s buyout of George Lucas’s theatre sound company THX, as well as YuuZoo’s purchase of a majority stake in Beverly Hills-based movie studio Relativity Media.

Mergers and acquisitions aside, Singapore startups exited through IPOs (initial public offerings) as well, though a few were overseas. CMON, a board games company, and Anacle, a property and energy management systems startup, both filed for a public listing on Hong Kong’s GEM (Growth Enterprise Market) board, citing greater publicity and liquidity.

Even as Singapore lost IPO opportunities, it is now home to two of South-east Asia’s largest tech unicorns. Garena is reportedly the highest-valued unicorn in the region with a US$3.5 billion price tag, while Grab is the highest-funded, having raised US$1.43 billion since its incorporation in 2012, going by the same Duff and Phelps report.

More funds were set up this year, many of which were backed by Chinese investors. Pang Shengdong invested S$5 million in Tembusu’s S$70-million ICT Fund I, while Stanley Zhang and George Gong co-founded Jubilee Capital Management, which rolled out a US$100-million tech fund. Venturecraft, whose investors are Alibaba co-founder Sun Tongyu and Xiamen Meitu Technology executive chairman Cai Wensheng, launched a S$50 million medtech fund.

Jeffrey Chi, SVCA chairman, said: “2016 has been a good year for entrepreneurship and startups in Singapore. The ecosystem is becoming more mature. Funding, talent and opportunities are becoming more readily available than before. We are currently in a virtuous cycle that will continue to feed itself as the ecosystem continues to develop.”

Meanwhile, startups have been acknowledged as vehicles for disruption and innovation by the Committee on the Future Economy (CFE), an entity set up by the Singapore government to develop strategies to build a vibrant and resilient economy. Janil Puthucheary, who chairs the CFE’s Group on Disruptive Technologies, said the government will work towards becoming a “flexible regulator”, so that legislation can catch up with startups and their new technologies and business models.

Coworking spaces – popular enclaves for startups and innovators – multiplied in 2016. A*START Central, a co-innovation lab for medtech and biotech firms, opened at the JTC LaunchPad @ one-north. Hub Singapore and The Working Capitol unveiled new coworking facilities at Cuppage Terrace and Robinson Road, respectively. Hong Kong-based The Work Project became the coworking space partner of OUE’s Downtown Gallery in Shenton Way. New player, Spacemob, opened in Claymore Hill with US$5.5 million in seed money.

Focal sectors – among them fintech and cybersecurity – saw prominent activity. For instance, there were at least three inaugural festivals held to celebrate entrepreneurship in these areas – the Singapore Week of Innovation & TECHnology (SWITCH), the Singapore FinTech Festival and the Singapore International Cyber Week.

Isaac Ho, chief of Venturecraft, said: “The fintech industry is receiving a lot of interest with the Singapore FinTech Festival and the Monetary Authority of Singapore’s Regulatory Sandbox for fintech experiments. I believe that fintech will continue to grow and receive strong investment interest locally and regionally.”

For all that, the startup space saw a few upsets during the year, raising age-old concerns about sustainability of new business models and VC funding. Several startups in Singapore closed down, including e-commerce sites Rakuten and Ensogo, ridesharing app Karhoo, and wireless charging solutions provider Novelsys.

Homegrown accelerator JFDI shut down its startup bootcamp programme, after it had raised some S$3 million to support over 70 startups, and is said to be a stalwart of South-east Asia’s tech startup ecosystem. JFDI cited high costs and a tight market for tech talent.

Additionally, e-grocer service RedMart was sold to Alibaba-owned Lazada for a reported US$40 million – an underwhelming price tag given that RedMart had raised over US$55 million from investors. The startup had reportedly chalked up an operating loss of US$21 million for 2014 and an operating loss margin of 78 per cent maintained from 2014.

A spokesman from Cocoon Capital, an early-stage VC fund, said: “The failure of RedMart to return a profit to its investors has surely been a slight damper. But overall, the market capitalisation of startups has seen a strong growth and a high number of follow-on funding rounds have been completed.” (See table)

Alex Lin, head of Infocomm Investments Pte Ltd (IIPL), said that the year’s developments point to Singapore being at the midpoint of a five-year strategy to transform its startup ecosystem. The strategy – initiated in 2014 by IIPL and now led by new entity SGInnovate (of which IIPL is a part) – has since accelerated over 300 startups. Of these, over 100 have gone on and raised Series A funding.

Dr Lin told BT: “This intensity has drastically changed the Singapore startup ecosystem and resulted in more stakeholders jumping on board the startup bandwagon.”

The spokesman from Cocoon Capital noted that there still needs to be more activity (such as acquisitions) to really put Singapore on the map. “However, we definitely see that South-east Asia and Singapore in particular are getting noticed by the global investor community.”

Xavier Pavie, a professor at ESSEC Business School, is hopeful. He said: “Singapore loves ecosystems. You can easily find partners, institutions and potential clients here. Universities and startups are very close, which is useful for finding fresh eyes and a young, motivated labour force. This diversity means there are greater chances to develop disruptive ideas.”

The startup space saw a few upsets during the year, raising age-old concerns about sustainability of new business models and VC funding. Several startups in Singapore closed down, including e-commerce sites Rakuten and Ensogo, ridesharing app Karhoo, and wireless charging solutions provider Novelsys.

This article was first published on Jan 3, 2017.
Get The Business Times for more stories.

Singapore

AS Singaporeans bid a sluggish 2016 adieu, expectations are running high for the Committee on the Future Economy’s (CFE) report – expected later this month – to be the panacea for all economic ills.

But experts say those anticipating big bang recommendations should temper such expectations, given the constraints surrounding Singapore’s more mature economy. The seeds may be cast for future growth, but there will unlikely be quick cures for Singapore’s economy.

CIMB Private Banking economist Song Seng Wun told The Business Times: “There’s a lot of expectation that this (30-member CFE panel) will come up with some magical solution – one that will transform this slower growth environment into something that will leap . . . But we already know we have to operate within certain constraints that all mature economies face – so it’s not like there is some magic wand that the government can wave to make us suddenly vibrant again so that everyone is happy.”

Still, it’s not hard to see why some may be holding out for a miracle pill in the CFE report, which is due for release by end-January. For starters, latest official indications peg 2016’s economic expansion at a mere one-plus per cent – a slowdown from 2015’s meagre 2 per cent, which already marked the country’s slowest pace of growth since 2009. The government will announce advance GDP estimates for Q4 and 2016 on Jan 3.

This has been exacerbated by heightened global uncertainty – not least due to the threat of “de-globalisation” from a looming Donald Trump presidency in the US, as well as talk of a pullback in China’s overseas investments.

Said UOB economist Francis Tan: “If we were living in a year where China is doing well and the global economy is fine, people wouldn’t really pay so much attention to the CFE report. But it’s coming at a time where there’s not much light at the end of any tunnel, so now people are hanging on to it like the last rung on a monkey bar. So people are saying: ‘Don’t worry, there’s still the CFE.’ But those expectations need to be tempered.”

This is especially since earlier strategies – such as picking winning sectors to kick-start economic growth – are far more difficult to execute today, given the rapidly changing global environment and ongoing trends of technological disruption.

Retooling the economy is more difficult these days too, given Singapore’s ageing demographics, anaemic productivity, and foreign labour restrictions. As a more mature economy, there is also a limit to how much infrastructure spending can boost Singapore’s expansion.

“The reality of today is that you can’t plan like how you used to,” stressed Mr Song.

As such, economists like Mr Song, Mr Tan, and Credit Suisse’s Michael Wan aren’t holding their breath for “anything groundbreaking” in the CFE report.

Said Mr Wan: “It’s not going to be big-bang reforms, but more of a continuation of what the government has already been trying to do over the past three to four years . . . There will likely be more of a push on technology and Smart Nation ambitions, perhaps some expansion of the SkillsFuture (initiative) to help encourage lifelong learning, and maybe some assistance to help workers cope with increased automation and disruptive technologies.”

And while those hoping for more may be disappointed by Mr Wan’s assessment, UOB’s Mr Tan thinks there’s no cause to be.

Said Mr Tan: “Traditionally, if you want to push growth, you’d stimulate capital, labour, and technology. Year after year, the government has already been stimulating all three . . . So maybe it’s not a bad thing that they continue on the journey, and keep at what they’ve been doing.”

Both he and Mr Wan think the move to restructure in a more targeted fashion – through the S$4.5 billion Industry Transformation Programme announced in Budget 2016 – is a good one, although they emphasise that its successful execution is crucial.

Noted Mr Wan: “The past policies (like the Productivity and Innovation Credit) have been prone to abuse. So by taking a more targeted approach, the general idea is right in that you can reduce the chance of abuse and cater more to individual sectors. But I think as with anything, implementation will be key – or else it could turn out essentially to be the same thing but wrapped in a different ribbon.”

Schemes and industry roadmaps aside, the common theme emerging in the lead-up to the CFE’s recommendations – at least according to private-sector economists – is that the CFE will be less about weaving magic to evaporate immediate concerns, and more about seeding Singapore’s long-term future.

This article was first published on Jan 3, 2017.
Get The Business Times for more stories.

Singapore’s Budget Statement for 2017 will be delivered by Minister for Finance Mr Heng Swee Keat in Parliament on Feb 20, said a statement on Tuesday (Jan 3).

The statement will be broadcast live on TV and radio. A live webcast will also be available as well on the Ministry of Finance’s (MOF’s) Singapore Budget website.

MOF will update its social media platforms on Facebook and Twitter with the latest announcements too.

Those who wish to receive the statement via e-mail after it has been delivered can go to the Singapore Budget website to subscribe to the mailing list.

This free service will be available for subscription from Jan 19 to Feb 19.

The public is encouraged to send in suggestions relevant to Budget 2017. The feedback exercise will end on Jan 13.

Feedback can be submitted here:

– Singapore Budget Website 

– REACH Discussion Forum

– REACH Budget microsite 

– REACH Singapore Facebook 

– REACH Singapore Twitter (Use the hashtag, #SGBudget2017)

– REACH Email Address 

– REACH Toll-Free Hotline 1800-353-5555 (Mon to Fri, 8.30am – 5.45pm)

– SMS 9-SPEAK-UP (9-77325-87)

A pre-Budget Facebook Q&A session will be held on Jan 4 from 8pm to 9.30pm. 

REACH will also stage the last Pre-Budget Listening Point on Jan 8 from 7.30am to 11.30am. It will be held at Hougang Hawker Centre, Blk 681, Hougang Ave 8.

debwong@sph.com.sg