Alcohol related liver disease (ALD) and non-alcoholic related fatty liver disease (NAFLD)
"Globally, the most prevalent cause of liver disease is alcohol. Interestingly, non-alcohol related fatty liver disease or simply called fatty liver disease is the next most common cause worldwide. It is predicted that over the present decade, fatty liver disease will overtake alcohol related liver disease (ALD) worldwide as the most common cause of liver disease. Studies from India have shown that prevalence of fatty liver is up to 30%, more than 50% have metabolic syndrome. Fatty liver is also the most common cause of unexplained rise in liver enzymes, end stage cirrhosis of unknown etiology and even liver cancer. Due to consumption of unhealthy, adulterated high calorie fast foods and sedentary life style, fatty liver is a growing public health problem in epidemic proportions. "
Alcohol related liver disease (ALD), as the name suggests, is related to liver disease in people consuming alcohol regularly and/or heavily. The new recommended safe amounts for alcohol consumption are that men and women should not drink more than 14 and 10 units of alcohol each week respectively. One alcohol unit is one 25ml single measure of whisky [(40% alcohol by volume (ABV)], or 150ml of beer (ABV 5-6%) or 90ml of red wine (ABV 12%). It is also recommended to drink alcohol slowly and along with food and sips of water in between. However, it is also important to note that quantity of alcohol consumed is not the only factor predicting the risk of liver disease. Even smaller quantities can lead to liver disease when associated risk factors are there such as obesity, fatty liver, binge drinking, co-existing viral hepatitis such as hepatitis B or hepatitis C, iron overload, family history of liver disease and so on. Hence, the take home message should be occasional small quantity alcohol and after food intake can be allowed. However, best is to avoid alcohol if a healthy secure future is considered important.
Liver has an extraordinary capacity to regenerate once the ongoing insult is alleviated. However, when the insult-damage-inflammation is unchecked, the liver gets progressively scarred and slowly goes into irreversible cirrhosis. Hence, it is prudent to identify the insult in the initial stages and immediately take necessary measures such as stopping alcohol completely or adopt strict diet and lifestyle modifications in case of fatty liver.
In initial stages, there may be no symptoms at all as liver has a large reserve and once symptoms such as jaundice or swelling of legs set in, means already considerable irreversible damage has already occurred and most of the times its beyond repair. Some people may notice some vague fatigue or dull pain in right upper abdomen on and off which are usually cast off as irrelevant symptoms but actual they may be warning signs of imminent danger. In those circumstances, labs will show raised liver enzymes with relatively preserved liver functions. This should ring bells and immediate medical attention sought.
When there is progression to liver failure, manifesting in form of jaundice, ascites or other signs of liver cell failure, then it is prudent to think about liver transplant as a long term definitive curative option provided the patient has stopped alcohol for considerable time to prevent post-transplant recidivism.
In case of NAFLD, once identified, it is important to start a low carbohydrate diet should be adopted along with daily exercise regimen anything like brisk walking or cycling or so on. This is the bedrock in management of NAFLD. Medications are usually required when there is ongoing inflammation in the liver as shown by lab tests or fibroscan to reverse the damage. But it is only successful when a strict diet and lifestyle modifications have already been instituted.
Dr Chandan Kumar KN
Senior Consultant - Hepatology & Lead Transplant Physician
Gleneagles Global Hospital Lakdikapul
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