Alcoholic fatty liver disease

With alcoholic fatty liver disease (AFLD), increasing amounts of fat are stored in the cells of the liver. AFLD is caused by regular, heavy consumption of alcohol. While AFLD is initially harmless, it can develop into serious diseases, such as fatty inflammation of the liver (steatohepatitis) or cirrhosis of the liver.

Provided that long-term damage has not already been done, AFLD can disappear naturally if the individual stops consuming alcohol. If the person is also suffering from alcohol dependence, this will need to be treated.

Many people with AFLD are not even aware that they have this illness. However, some experience symptoms such as a loss of appetite, nausea, and vomiting. 

Alcohol is broken down in the liver. Consuming large amounts of alcohol can impair liver function and destroy or alter liver cells. In addition, fatty acids are produced when alcohol is broken down, which are stored in the liver. If large volumes of alcohol are consumed on a regular basis, a large amount of fat may accumulate in the liver.

Binge drinking also increases the risk of developing a fatty liver. Binge drinking refers to the consumption of a large volume of alcohol within a small amount of time – roughly 1.25 liters of beer or 0.6 liters of wine for men, and 1 liter of beer or 0.5 liters of wine for women.

In addition to excessive alcohol consumption, the following factors also increase the risk of developing a fatty liver: 

• being heavily overweight (obesity)
• genetic factors
• other diseases of the liver, such as chronic viral hepatitis
• smoking

Fatty liver also develops more rapidly in women than men. 

No accurate figures are available to indicate how common AFLD is because this illness almost always develops without any symptoms. However, studies suggest that approximately 90 percent of those who drink large quantities of alcohol over an extended period will develop fatty liver disease. For a man, this would be equivalent to two bottles of beer or more per day.

If a person with AFLD completely abstains from drinking alcohol, the change in the liver is quickly reversed.

AFLD is the mildest alcohol-related disease of the liver. Having AFLD increases the risk of developing fatty inflammation of the liver and, later, cirrhosis of the liver – a serious disease that can be fatal.

Various findings can indicate the presence of AFLD. These include:

• a palpably enlarge liver
• an increased level of a specific liver enzyme in the blood

If there is reason to suspect fatty liver disease, this can be verified in most cases using imaging techniques, such as an ultrasound scan. Taking a biopsy (a tissue sample) is rarely necessary.

To clearly distinguish between non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD), doctors will also find out from the patients exactly how much alcohol they consume and how often.

The only treatment for alcoholic fatty liver disease is to abstain from drinking alcohol. With total abstention, a full recovery is possible.

If alcohol dependence is diagnosed in addition to AFLD, it is essential that this dependence be treated. 

As heavy alcohol consumption is frequently associated with nutrient deficiency, it is recommended that the patient adopt a balanced, nutrient-rich diet.

The Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung – BZgA) provides information about managing alcohol consumption and on self-help options on their kenn-dein-limit.de (“know your limit”) website. Anyone who would like to find out if their alcohol consumption is excessive can take a self-test.

For detailed information, including options for people who have a loved one with alcohol issues, visit gesundheitsinformation.de.