Alcoholic Fatty Liver Disease: Signs, Symptoms & Outlook
Fatty liver disease, also known as hepatic steatosis, is a condition caused by the storage of extra fat in the liver, which, over time, makes it harder for the liver to process nutrients, remove poisons, and store energy effectively. 1 If the condition worsens, it can cause further, irreparable liver injury.2
What is Fatty Liver Disease?
Fatty liver disease is a condition where significant levels of fat build up in your liver.3 It’s normal for there to be some fat in the liver, but if the liver has more than 5–10% of its weight in fat, then it is considered a fatty liver 3
Fatty liver disease falls into two main categories.
- Nonalcoholic Fatty Liver Disease (NAFLD) is not caused by heavy alcohol use and is further divided into two subtypes:
- Nonalcoholic fatty liver (NAFL): Sometimes referred to as simple fatty liver, NAFL is a milder form of NAFLD. It rarely causes inflammation or liver damage though some individuals experience pain due to an enlarged liver. It’s estimated to affect 24% of U.S. adults.1
- Nonalcoholic steatohepatitis (NASH): This is a less common, more serious form of NAFLD. It affects less than 7% of U.S. adults.1 NASH causes inflammation and cell damage that can lead to complications, including scarring (fibrosis), permanent scarring that leads to shrinkage and hardening of the liver (cirrhosis), liver cancer, and liver failure.3
- Alcoholic Fatty Liver, a completely preventable condition, occurs quickly in those who drink heavily, and affects nearly all heavy drinkers.2 In the early stages, the condition is reversible if individuals commit to abstaining from alcohol. For those who continue to misuse alcohol, alcoholic fatty liver can progress to inflammation, swelling, and the destruction of liver cells (also known as alcoholic hepatitis) and can eventually progress to alcoholic cirrhosis (scarring and shrinkage of the liver).2
Symptoms of Alcoholic Fatty Liver Disease
Excessive alcohol consumption—defined as more than 21 drinks per week for men and over 14 drinks per week for women4—causes a multitude of harmful effects on the body and can lead to alcoholic fatty liver.3 In fact, on the spectrum of alcoholic liver diseases (ALD), alcoholic fatty liver is typically the first disorder to occur. It’s estimated to affect more than 80% of heavy drinkers.5 However, it can be hard to detect because the disease is often asymptomatic.3
When symptoms do present, they can include:1,7
- Abdominal pain.
- Loss of appetite.
Statistics suggest that one in five heavy drinkers will progress from alcoholic fatty liver to alcoholic-related hepatitis, which can be mild or severe.6 In mild cases, alcohol-related hepatitis can last for years, cause progressive liver damage, but be reversed in the early stages if alcohol consumption stops. In severe, acute instances, the condition occurs suddenly—after a night of binge drinking, for instance—and leads to life-threatening complications. Symptoms of alcohol-related hepatitis may include:6
- Jaundice (yellowing of the skin and eyes).
- Abdominal tenderness.
One in four heavy drinkers will advance from alcoholic hepatitis to alcoholic cirrhosis. In addition to the alcoholic hepatitis symptoms, individuals with alcohol-related cirrhosis may have:6
- Ascites, the accumulation of fluid in the abdomen.
- Portal hypertension caused by high blood pressure in the liver.
- Esophageal varices, which means that veins in the esophagus bleed.
- Changes in behavior.
- An enlarged spleen.
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Causes and Risk Factors of ALD
While different factors, such as metabolism, genetics, and the environment play a role in ALD, chronic alcohol use over many years is the primary cause of ALD. The risk for ALD increases with chronic and heavy alcohol use. However, since some chronic drinkers never get ALD, there are other factors that increase an individual’s susceptibility, including:2,8
- Weight. Obesity contributes to fatty liver disease, and alcohol exacerbates it.
- Malnutrition. A lack of proper nutrition damages liver cells. In some cases, people with ALD don’t have an appetite. In other instances, the excessive alcohol consumption prevents the body’s ability to properly break down food and absorb nutrients.
- Genetics. Studies suggest that there may be a genetic component to ALD.
- Race and ethnicity. Research indicates that Hispanic men, especially those of Mexican descent have the highest risk of alcohol-related cirrhosis and seem to develop it at a younger age than their Caucasian or Black counterparts. In addition, Native American Indians and Native Alaskans seem to have a higher mortality rate from chromic ALD compared to other ethnicities.
- Genetics. While men consume alcohol more than women and consequently, are nine times more likely to develop an ALD, women have greater risk factors for ALD. These gender-specific risk factors include estrogen’s effects on the liver and the predisposition of having a higher blood alcohol concentration.
- Age. Adolescents and older adults are two populations at a greater risk of developing ALDs. Research shows that adolescents who begin drinking before age 14 have a greater likelihood of developing an alcohol use disorder (AUD), a medical condition defined by the inability to control alcohol consumption despite harmful consequences. Older adults metabolize alcohol more slowly. Therefore, they may be more susceptible to alcohol-related liver problems.
- Viral hepatitis. Individuals with hepatitis C, a liver infection, who also drink heavily, risk developing advanced ALD.
Treatment of Alcoholic Fatty Liver Disease
Individuals with ALD are not only living with liver disease but most likely also are living with an AUD. Therefore, treatment needs to target both disorders.7
Treatment for AUDs aim to achieve alcohol abstinence through various strategies. These may include the medical management of alcohol withdrawal symptoms, counseling, behavioral therapy, medications, outpatient rehab, or residential inpatient treatment. It’s important to discuss the best options for you with your health care provider and finding the right treatment program to address all your needs.2,7
Addressing the alcohol addiction is the first—and most important—step in ALD treatment. From there, other treatments may include:2,5,9
- Nutritional support: Nutritional therapy is dependent on the severity of the liver disease, and the presence of other conditions such as anorexia or obesity. Support may include dietary counseling, supplement recommendations, electrolyte repletion, and more.
- Medications: Studies indicate that individuals with alcoholic hepatitis might benefit (in the short term) from steroid therapy to help reduce liver inflammation.
- Liver transplant: For individuals with end-stage alcoholic cirrhosis, a liver transplant is the only definitive treatment, and it’s proven to be successful in those who abstain from alcohol for the rest of their life.
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Impacts and Outlook of Alcoholic Fatty Liver Disease
Individuals with alcoholic fatty liver disease can improve—even reverse—the damage if they stop drinking alcohol.10 Evidence shows that even if alcoholic fatty liver has progressed to fibrosis, the liver can repair and regenerate itself if alcohol consumption is stopped.10
In addition, there are some other lifestyle changes that can help improve liver wellness, including:11
- Eliminating alcohol.
- Eating a balanced diet, including fiber, meat, dairy, and monounsaturated and polyunsaturated fats.
- Exercising regularly.
- Avoiding illicit drug use.
- Practicing safe sex to minimize the risks of contracting hepatitis B or C.
- Getting vaccinated for the flu, pneumococcal disease, and hepatitis A and B.
For individuals with ALD who continue to drink alcohol, the prognosis is poor. At a certain point, damage done to the liver is irreversible. Alcoholic cirrhosis may lead to liver cancer, liver failure, and death.10
- National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.) Nonalcoholic Fatty Liver Disease (NAFLD) & NASH.
- American Liver Foundation. (n.d.) Alcohol-related liver disease.
- American Liver Foundation. (n.d.) Nonalcoholic fatty liver disease (NAFLD).
- Patel, Roshan, and Mueller, Matthew. (August 30, 2021). Alcoholic Liver Disease. StatPearls Publishing.
- Saberi, B., Dadabhai, A. S., Jang, Y. Y., Gurakar, A., & Mezey, E. (2016). Current management of alcoholic hepatitis and future therapies. Journal of clinical and translational hepatology, 4(2), 113–122.
- American Liver Foundation. (2017). Alcohol-Related Liver Disease
- Singal, Ashwani K MD, MS, FACG; Bataller, Ramon MD, Ph.D., FACG; Ahn, Joseph MD, MS, FACG; Kamath, Patrick S MD; Shah, Vijay H MD, FACG. (2018). ACG clinical guideline: alcoholic liver disease. American Journal of Gastroenterology, 2(175-194).
- Meroni, Marica, Longo, Miriam, Rametta, Raffaela, and Dongiovanni, Paola. (2018). Genetic and Epigenetic Modifiers of Alcoholic Liver Disease. International Journal of Molecular Sciences, 19(12), 3,857.
- Frazier, Thomas H., M.D., Stocker, Abigail M., M.D., Kershner, Nicole A., M.D., Marsano, Luis S., M.D., McClain, Craig J., M.D. (2011). Treatment of alcoholic liver disease. Therapeutic Advances in Gatroenterology, 4(1), 63-81.
- American Liver Foundation. (n.d.) The progression of liver disease.
- American Liver Foundation. (n.d.) 13 Ways to a Healthy Liver.