What is alcoholic fatty liver disease (AFLD)?

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Alcoholic fatty liver disease (AFLD) is the build-up of fat in the liver as a consequence of excessive use of alcohol. It is the mildest kind of alcohol-related liver disease (ARLD), which, with continued alcohol use, will progress to more serious types such as alcoholic hepatitis, cirrhosis, and liver cancer.

Main Characteristics of Alcoholic Fatty Liver Disease (AFLD):
Accumulation of Fat: AFLD is brought about by fat (triglycerides) accumulated in the liver cells due to excessive use of alcohol. The accumulated fat is usually reversible if alcohol use is stopped, but frequent intake of alcohol could lead to further liver damage.

Causes:

Heavy alcohol consumption: Heavy and regular intake of alcohol is the chief etiology of AFLD. The liver metabolizes alcohol and, with sustained intake of too much alcohol, overwhelms the liver’s ability to metabolize fat, and thus it begins to deposit fat into liver cells.

The specific mechanism of fat buildup is complex but is related to the effect of alcohol on fat metabolism by the liver. Alcohol causes the liver to produce more fat and prevents the breakdown and exportation of fat from the liver.

Risk Factors

Heavy drinking: The more, and the longer a person consumes liquor, the more likely are AFLD symptoms. Drinking a weekly total in excess of 14 drinks in females or 21 drinks weekly for males typically falls into this category and contributes to the development of AFLD.

Hereditary: Familial tendencies lie with some patients who develop AFLD despite modest use.

Obesity and metabolic syndrome: People who are obese or have metabolic syndrome (a cluster of conditions including high blood pressure, high blood sugar, and high cholesterol) might be at higher risk of developing AFLD after drinking alcohol.

Symptoms:

In the early stages of AFLD, the disease is usually asymptomatic, but as AFLD progresses, some people may experience:

Fatigue

Pain or feeling bloated in the upper right abdomen

Weight loss or loss of appetite

Jaundice (yellowing of the skin or eyes) in advanced stages

But AFLD is normally silent until it becomes more severe liver damage.

Diagnosis:

History: One of the key elements in diagnosing AFLD is a thorough history of alcohol consumption. Doctors will question the patient concerning drinking habits, including how much, how frequently, and how long they have been drinking alcohol.

Blood tests: Liver function tests can show elevated levels of liver enzymes like ALT (alanine aminotransferase) and AST (aspartate aminotransferase). They are elevated due to liver inflammation caused by alcohol consumption.

Imaging: Liver ultrasound or CT scan can detect fatty accumulation in the liver.

Exclusion of other causes: One should exclude other possible causes of fatty liver, including non-alcoholic fatty liver disease (NAFLD), which is similar in its presentation but is not alcohol-related.

Treatment and Management:

Abstinence from alcohol: Total abstinence from alcohol is the optimal treatment for AFLD. The liver is highly capable of self-recovery, and alcohol abstinence can reverse the liver’s fat accumulation and halt the damage.

Healthy diet and weight management: Consuming a healthy diet and managing weight can help reduce liver fat. A low-fat, high-fiber, fruit, and vegetable diet may help maintain liver health.

Exercise: Physical activity is helpful in lowering liver fat and overall metabolic health.

Medications: There is no specific medication for AFLD, but management of allied diseases like diabetes, hypercholesterolemia, or hypertension can prevent progressive liver damage.

Prognosis:

Reversible at early stages: During early stages of AFLD, liver damage is reversible if alcohol consumption is avoided. The liver recovers and regains normal function.

Progression: If drinking continues, AFLD can progress to more severe conditions, including alcoholic hepatitis, cirrhosis, and liver failure. Cirrhosis is irreversible and significantly increases the risk of liver cancer.

Liver transplant: In severe cases, especially if cirrhosis or liver failure occurs, a liver transplant is necessary.

Complications:

Alcoholic hepatitis: Chronic inflammation of the liver, which can cause jaundice, fever, and abdominal pain.

Cirrhosis: Scarring of the liver tissue that is irreversible, impairing liver function and leading to potential complications like liver failure and portal hypertension.

Risk of liver cancer included: Chronic alcohol use and liver damage increase the risk of hepatocellular carcinoma (liver cancer).

Conclusion
AFLD is a normal condition created by heavy drinking, where the liver becomes fatty. AFLD may be asymptomatic in the early stages but progress to more severe liver diseases if alcohol consumption continues. Alcohol avoidance is the primary management of AFLD, and early treatment has a good prognosis. However, continued alcohol intake can lead to irreversible liver damage, including cirrhosis and liver carcinoma. Routine medical check-ups and lifestyle changes such as weight control and exercise are necessary for controlling the condition.
Non-alcoholic steatohepatitis (NASH) is a more severe form of non-alcoholic fatty liver disease (NAFLD) involving not just fat deposition in the liver, but also inflammation and liver cell damage. Unlike simple NAFLD, where it tends to lead to fat buildup without extensive damage to the liver or inflammation, NASH can lead to cumulative liver damage and fibrosis. If left untreated, NASH can eventually progress to cirrhosis of the liver and increase the risk of liver cancer.

Key Features of NASH:
Fat Accumulation and Inflammation:

The liver cells in NASH accumulate fat (like NAFLD), but are also inflamed. This inflammation damages the liver cells, which results in scarring (fibrosis). Later on, this results in more serious scarring, known as cirrhosis, and ultimately liver failure.

Risk Factors:

The risk factors for NASH are also identical to those of NAFLD. These are:

Obesity (especially abdominal obesity)

Type 2 diabetes

Metabolic syndrome (collection of conditions such as high blood pressure, high blood sugar, and abnormal cholesterol)

High triglycerides or cholesterol

Age (people over 40 years of age are at higher risk)

Gender (men are more likely to develop NASH at a younger age, though postmenopausal women are also at increased risk)

Genetic predisposition (family history of liver disease)

Lack of exercise and poor diet (high in processed food, refined carbs, and unhealthy fat)

Symptoms:

Similar to NAFLD, NASH is usually asymptomatic at first. As the disease advances, patients may have:

Fatigue

Discomfort or pain in the upper right quadrant of the abdomen

Weight loss for no known reason

Enlarged liver (hepatomegaly)

Because the disease is usually symptom-free at first, many people will not know they have NASH until liver damage is more extensive.

Diagnosis:

NASH is typically diagnosed by a combination of blood tests, imaging studies, and sometimes a liver biopsy. Key diagnostic tools are:

Liver function tests: Blood tests that check for elevated levels of liver enzymes (AST, ALT) that indicate liver inflammation or damage.

Ultrasound or CT scan: Imaging tests that can detect fat in the liver and liver enlargement.

FibroScan (Transient Elastography): An outpatient imaging test in which the hardness of the liver is measured. This can disclose the severity of fibrosis (scarring) in the liver.

Liver biopsy: A procedure in which some liver tissue is taken out and examined under the microscope to render the diagnosis of NASH and to determine the severity of the liver damage. It is the most absolute test to render the diagnosis of NASH and to determine the amount of fibrosis.

Stages of NASH

Simple Steatosis: Early stages of fatty liver without inflammation or liver cell damage. It is usually harmless but can progress to NASH.

NASH: Characterized by fat deposition, inflammation, and liver cell damage. This stage can progress to fibrosis (scarring).

Cirrhosis: Untreated NASH can lead to extensive scarring of the liver (cirrhosis), impairing liver function. Cirrhosis can result in liver failure and require a liver transplant.

Liver Cancer: In advanced cirrhosis, there is a higher risk of developing hepatocellular carcinoma (liver cancer).

Treatment and Management:

There is no approved drug available for NASH at present, but lifestyle modifications are the mainstay of treatment. The aim is to decrease liver fat, inflammation, and prevent cirrhosis. Treatment options include:

Weight loss: Gradually and continuously reducing weight by eating a healthy and balanced diet along with regular physical activity may reduce liver fat and inflammation. Even losing 5-10% of body weight can significantly improve the function of the liver.

Balanced meal plan: A balanced diet of fruits, vegetables, whole grains, and lean proteins with low consumption of processed food, refined carbs, and unhealthy fats is recommended to manage NASH.

Exercise: Regular aerobic exercise (e.g., walking, swimming, cycling) enhances insulin sensitivity, reduces liver fat, and controls other risk factors like high blood pressure and cholesterol.

Treatment of underlying conditions: Type 2 diabetes, high cholesterol, high triglycerides, and high blood pressure should be managed effectively to prevent further liver injury.

Medication: There are no specific medications licensed for NASH, but medications employed to treat risk factors such as diabetes, hypercholesterolemia, and obesity may be able to control the disease.

Vitamin E: Supplementation with Vitamin E can be recommended in some patients with NASH due to its antioxidant activity on reducing liver inflammation in patients with NASH, but this is typically reserved for non-cirrhotic and non-diabetic patients. Vitamins.

Bariatric surgery: In individuals with severe obesity, bariatric surgery (eg, gastric bypass) may be an option if lifestyle modification is not sufficient to manage NASH.

Prognosis:

In the early phase, NASH can usually be managed and sometimes reversed by modifying lifestyle through weight loss, change in diet, and exercise.

But if left untreated, NASH can progress to severe types of liver disease, such as fibrosis, cirrhosis, and liver failure, requiring a liver transplant. NASH has also been associated with a higher risk of liver cancer.

Conclusion:
Non-alcoholic steatohepatitis (NASH) is a more severe form of non-alcoholic fatty liver disease (NAFLD), in which not only does fat accumulate in the liver but also inflammation and injury to liver cells. NASH can progress to fibrosis, cirrhosis, and even to liver cancer in case of no treatment. Lifestyle modification, particularly weight loss and management of underlying diseases such as diabetes and hypercholesterolemia, are the primary treatments for NASH. Early diagnosis and treatment are crucial in order to prevent progression to advanced liver damage and complications.