CONDITIONS
Fatty Liver disease
Fatty Liver disease (Alcohol-related)
The largest organ inside the body is the liver and helps in digesting food, storing energy, and removing toxins. Fatty liver disease is a condition in which fat builds up in your liver. There are two main types of fatty liver –
- Nonalcoholic fatty liver disease (NAFLD)
- Alcoholic-related fatty liver disease, also called alcoholic steatohepatitis (ALD)
Alcoholic fatty liver (ALD) occurs due to heavy alcohol intake. The liver breaks down the ingested alcohol to remove it from the body. However, this process generates harmful substances that damage liver cells, promote inflammation, and weaken the body’s natural defenses.
Alcoholic fatty liver disease is the first stage of alcohol-related liver disease. The next stages are alcoholic hepatitis and cirrhosis. ALD accounts for 4% of mortality globally and around 50% of liver cirrhosis related deaths of are directly or indirectly related to alcohol.
What are the symptoms of Fatty Liver ?
There are usually no symptoms with ALD, but some people suffer from tiredness or pain in the upper right side of the belly (at location of the liver).
Inadvanced stages of acute hepatitis and cirrhosis, the symptoms may include:
- Itchy skin.
- Unexplained weight loss
- Abdominal swelling
- Breathlessness
- Swelling seen in the legs.
- Spider-like blood vessels just beneath the skin’s surface.
- Red palms.
- Yellowing of the skin and eyes, or jaundice.
- Weakness.
- Kidney Failure
What are the causes of Fatty Liver?
Excessive alcohol consumption is the primary cause of ALD. Additional risk factors to increase chances of getting ALD along with drinking alcohol is:
- Overweight or obesity
- Improper nutrition
- Have chronic viral hepatitis, especially hepatitis C
- Are African American, Hispanic male
- Are older – the older you are, the more likely it becomes
- Are obese
- Are malnourished
- Have chronic viral hepatitis, especially hepatitis C
- Are an African American or Hispanic male or have male anatomy
- Aging
What is unhealthy drinking or heavy alcohol use?
Heavy alcohol use as defined by National Institutes of Health in 2023 is:
- – For men, consuming 5 or more drinks on any day or 15 or more drinks per week
- – For women, consuming 4 or more drinks on any day or 8 or more drinks per week
One standard drink has 14 grams of pure alcohol (ethanol) as per global standards. This may differ as per the type of drink such as beer, wine ,gin, etc.
What are the diagnostic tests for Fatty Liver?
Generally, ALD shows no symptoms and it is often found when tests for other reasons point to liver problems or if a person undergoes routine diagnostic tests and that shows a high level of liver enzymes leading to further testing and diagnosis.
It is important to tell the truth about the alcohol consumption when and if the doctor takes a medical history.
Blood Tests:
Blood tests may not always indicate ALD. A blood test called the Liver Function test (LFT) is conducted and its abnormal result and if other conditions such as hepatitis is ruled out, ALD is diagnosed.
Imaging tests: To fat deposits in liver.
- Special ultrasound and MRI scans helps in spotting scar tissue in the liver.
- Transient elastography measures liver stiffness using a special ultrasound machine.
Liver Biopsy:
- The only way sure shot way to be certain that fatty liver disease is the only cause of liver damage is with a liver biopsy.
- A liver biopsy involves getting a tissue sample of your liver with a needle.
- The needle removes a tiny piece of liver tissue that is seen under a microscope.
What are the treatment options for ALD?
Treatment goal is to restore some or all normal function to the liver.
Immediately stop consuming all alcohol if you have acute hepatitis or cirrhosis.
Talk to the doctor to suggest a therapist or enrol into an alcohol recovery program if required. Certain medicines can help in reducing alcohol cravings or even make a person sick if they drink alcohol.
In people with liver cirrhosis, liver transplant is suggested.
Can You Prevent ALD?
To prevent ALD:
Drink in moderation: That’s one drink a day for men over 65 and women of all ages, and up to two drinks for men 65 and younger.
Protect yourself from hepatitis C: This viral liver infection can make you more likely to get cirrhosis if you drink.
Be careful of medicating with alcohol: Ask the doctor if drinking alcohol with any prescribed medicines is allowed. This is because alcohol interacts with some medicines and make the medicines react in different manner.
References
- Mitra S, De A, Chowdhury A. Epidemiology of non-alcoholic and alcoholic fatty liver diseases. Transl Gastroenterol Hepatol. 2020 Apr 5; 5:16.
- Fatty liver disease. Medline Plus. March 2024. https://medlineplus.gov/fattyliverdisease.html
- Non-alcoholic fatty liver disease (NAFLD). NHS UK. March 2024. https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/
- Fatty Liver: Causes, Symptoms, and Treatment. WebMD. March 2024. https://www.webmd.com/hepatitis/fatty-liver-disease
