Alcoholic fatty liver, which may occur after even moderate (about 10g per day) consumption of alcohol [1], is invariably found in people who drink heavily [2]. It is the initial stage in alcoholic liver disease when pathologic changes are reversible. Consumption of excessive amounts of alcohol over extended periods will lead to the appearance of more severe manifestations, such as alcoholic hepatitis and cirrhosis.

The buildup of fats (triglycerides) in the liver is the consequence of the metabolism of alcohol by the liver. The enzymes that oxidize alcohol to the toxic acetaldehyde and then to acetic acid also produce reduced nicotinamide adenine dinucleotide (NADH). Excess NADH inhibits the oxidation of fatty acids and promotes their synthesis, which favors their accumulation in the form of triglycerides [3]. A multitude of other molecular and cellular effects of alcohol metabolism, such as oxidative stress, and the activation of hepatic macrophages, leads to further damage, inflammation, and fibrosis.

Alcoholic fatty liver does not usually cause symptoms. Hepatomegaly may be observed and supports the diagnosis. Rare symptoms are portal hypertension and extrahepatic problems such as muscle wasting, cardiomyopathy, and pancreatitis. Cholestasis is another rare occurrence in people with fatty liver. The American Association for the Study of Liver Diseases recommends using an organized questionnaire if excessive alcohol consumption is suspected [4].

• Fatigue

  However, when symptoms do occur, they may include: Fatigue and weakness Weight loss, loss of appetite, and nausea Abdominal pain Jaundice (yellowing of the skin and eyes) Itching Fluid retention or swelling of the legs and abdomen Mental confusion Prevalence [upmc.com]

  Let your doctor know if you’ve been experiencing fatigue or loss of appetite. Also, tell your doctor about any history of alcohol, medication, and supplement use. [healthline.com]

  Symptoms of cirrhosis may include fatigue, bleeding easily, easy bruising, fluid accumulation in the abdomen ( ascites ), loss of appetite, nausea, swelling in the legs (edema) and weight loss. [liversupport.com]

• Swelling

  If left untreated, NAFLD may lead to swelling and scarring (cirrhosis) in the liver. Over time, it may even lead to liver cancer or liver failure. Treatment for NAFLD There are no medical treatments yet for NAFLD. [upmc.com]

  Alcohol causes inflammation and swelling in your liver. Over a period of time, if this abuse continues, the liver becomes scarred and you have cirrhosis of the liver, which is the final phase of alcoholic liver disease. [fattyliverdietguide.org]

  If symptoms appear, they may include: A feeling of fullness in the middle or upper right side of the abdomen Abdominal pain Loss of appetite or weight loss Nausea Weakness Jaundice (yellowing of the skin and the whites of the eyes) Swelling of the abdomen [my.clevelandclinic.org]

  If cirrhosis develops, sufferers can develop severe symptoms such as yellowing of the skin and the whites of the eyes and swelling in the legs, ankles, feet or tummy. [express.co.uk]

• Fishing

  For nonalcoholic fatty liver disease, interventions include lifestyle changes like weight loss; exercise; a diet rich in natural fruits, vegetables and whole grains; increased consumption of healthy fats contained in fish, nuts and olive oil; and a reduction [livestrong.com]

  Eat fatty fish (e.g., salmon, trout, sardines) twice a week to get anti-inflammatory omega-3 fatty acids. If you have high blood triglycerides, speak to your dietitian or doctor about fish oil supplementation. [theglobeandmail.com]

  Increase your consumption of omega 3 fatty acids from wild fish, chia and flax seeds, and walnuts. Drink less. Finally, start moving. Get off the couch, and aim for 10,000 steps a day. [today.com]

  Replace red meats with lean proteins such as soy, chicken, turkey, and fish. Sweetened drinks, juices, and sodas should be avoided. Most cases of fatty liver don’t progress into other forms of liver disease. [healthline.com]

• Chronic Infection

  Coppola, Impact of PNPLA3 variants on liver histology of 168 patients with HIV infection and chronic hepatitis C, Clinical Microbiology and Infection, 10.1016/j.cmi.2015.11.025, 22, 4, (372-378), (2016). [dx.doi.org]

• Abdominal Pain

  However, when symptoms do occur, they may include: Fatigue and weakness Weight loss, loss of appetite, and nausea Abdominal pain Jaundice (yellowing of the skin and eyes) Itching Fluid retention or swelling of the legs and abdomen Mental confusion Prevalence [upmc.com]

  If symptoms appear, they may include: A feeling of fullness in the middle or upper right side of the abdomen Abdominal pain Loss of appetite or weight loss Nausea Weakness Jaundice (yellowing of the skin and the whites of the eyes) Swelling of the abdomen [my.clevelandclinic.org]

  These can include: appetite loss nausea vomiting abdominal pain jaundice Most cases of NASH are detected in people between ages 40 and 60, according to the American Liver Foundation. [healthline.com]

• Loss of Appetite

  However, when symptoms do occur, they may include: Fatigue and weakness Weight loss, loss of appetite, and nausea Abdominal pain Jaundice (yellowing of the skin and eyes) Itching Fluid retention or swelling of the legs and abdomen Mental confusion Prevalence [upmc.com]

  Symptoms of cirrhosis may include fatigue, bleeding easily, easy bruising, fluid accumulation in the abdomen ( ascites ), loss of appetite, nausea, swelling in the legs (edema) and weight loss. [liversupport.com]

  If symptoms appear, they may include: A feeling of fullness in the middle or upper right side of the abdomen Abdominal pain Loss of appetite or weight loss Nausea Weakness Jaundice (yellowing of the skin and the whites of the eyes) Swelling of the abdomen [my.clevelandclinic.org]

  These include fatigue, loss of appetite, weight loss, weakness, fluid retention, or bleeding. [hopkinsmedicine.org]

• Jaundice

  In addition to jaundice and marked hepatomegaly, the patient presented with hypocalcemic crisis associated with hypomagnesemia, low plasma 1,25(OH)2-vitamin D and undetectable plasma parathyroid hormone (PTH) concentration. [ncbi.nlm.nih.gov]

  Your doctor weighs you and checks your body for signs of liver problems such as an enlarged liver or jaundice. Blood tests. [webmd.com]

  However, when symptoms do occur, they may include: Fatigue and weakness Weight loss, loss of appetite, and nausea Abdominal pain Jaundice (yellowing of the skin and eyes) Itching Fluid retention or swelling of the legs and abdomen Mental confusion Prevalence [upmc.com]

• Hepatomegaly

  In addition to jaundice and marked hepatomegaly, the patient presented with hypocalcemic crisis associated with hypomagnesemia, low plasma 1,25(OH)2-vitamin D and undetectable plasma parathyroid hormone (PTH) concentration. [ncbi.nlm.nih.gov]

  Hepatomegaly may be observed and supports the diagnosis. Rare symptoms are portal hypertension and extrahepatic problems such as muscle wasting, cardiomyopathy, and pancreatitis. Cholestasis is another rare occurrence in people with fatty liver. [symptoma.com]

  Most individuals are asymptomatic and are usually discovered incidentally because of abnormal liver function tests or hepatomegaly noted in unrelated medical conditions. Elevated liver biochemistry is found in 50% of patients with simple steatosis. [en.wikipedia.org]

  Characteristic ultrasonographic findings include a hyperechoic liver with or without hepatomegaly. Computed tomography (CT) and magnetic resonance imaging (MRI) can readily detect cirrhosis. [clevelandclinicmeded.com]

• Agitation

  A rapid reduction in alcohol can lead to withdrawal symptoms including anxiety, agitation, hallucinations and seizures. Your doctor can recommend a program that best meets your needs. [liverfoundation.org]

Patient history is extremely important because fatty liver can occur in obese patients and in conditions of hyperlipidemia, insulin resistance, and malnutrition, and can be caused by various drugs. However, patient history may not be accurate, and single biomarkers (for example, amino acid transferase or gamma-glutamyl transpeptidase levels) do not distinguish efficiently between alcoholic and non-alcoholic hepatic steatosis. However, a combination of results of diagnostic markers can differentiate between the two types of conditions reliably [5] [6].

In alcoholic liver disease, laboratory studies show elevated aminotransferases (aspartate aminotransferase and alanine aminotransferase) in about 30% of the patients, with aspartate aminotransferase being higher than alanine aminotransferase. Bilirubin concentrations may also be elevated because of hemolysis.

Liver biopsy is not usually performed for fatty liver but may be useful to exclude more advanced disease (steatohepatitis or fibrosis), or other unrelated conditions that cause liver damage. The biopsy of fatty liver will show fat accumulation in the hepatocytes, which tends to be macrovesicular, consisting of a single or very few large lipid droplets resulting in the displacement of the nucleus to a peripheral position. Microvesicular lipid accumulation is sometimes observed, which leads to foamy degeneration of hepatocytes [7]. Fatty deposition most often affects the centrilobular part of the acinus, but in advanced cases of fatty liver, the whole acinus is affected [8].

Ultrasonography, computed tomography, and magnetic resonance imaging can demonstrate the condition of steatosis in a patient. Ultrasonography shows a diffusely echogenic liver in alcoholic steatosis.

• Liver Biopsy

  Patients with paired liver biopsies and LSM were followed prospectively for liver-related and non-liver related complications, and survival. RESULTS: The data for 113 biopsy-proven NAFLD patients (mean age 51.3 ± 10.6 years, male 50%) were analyzed. [ncbi.nlm.nih.gov]

  Liver biopsy remains the criterion standard for the diagnosis of nonalcoholic steatohepatitis. Noninvasive tests are available and may reduce the need for liver biopsy. [aafp.org]

We review herein the current management of non-alcoholic fatty liver disease, including dietary and physical activity interventions, available treatments, equivocal therapies, emerging treatments, and treatments presently in clinical trials. [ncbi.nlm.nih.gov]

KEYWORDS: Cardio-hepatic syndrome; Chronic heart failure; Prognosis [ncbi.nlm.nih.gov]

The long-term prognosis. Am J Gastroenterol 1971; 56(6):515–525. Bonis PA, Friedman SL, Kaplan MM. Is liver fibrosis reversible? N Engl J Med 2001; 344(6):452–454. Romano DR, Jiménez C, Rodriguez F, et al. [clevelandclinicmeded.com]

There are limited data on transplant survival in patients transplanted for acute alcoholic hepatitis, but it is believed to be similar to that in nonacute ALD, non-ALD, and alcoholic hepatitis with MDF less than 32. [20] Prognosis [ edit ] The prognosis [en.wikipedia.org]

C 2, 13, 17 Liver biopsy is the criterion standard for diagnosis and prognosis of nonalcoholic fatty liver disease. [aafp.org]

Abstract Nonalcoholic fatty liver disease (NAFLD) is a burgeoning health problem of unknown etiology that varies in prevalence among ancestry groups. [dx.doi.org]

The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol. 2003;98:960-7. [revistas.proeditio.com]

Progression of NASH histological lesions is not always precluded by measures that target the etiological factors of NASH, as those mentioned above. [doi.org]

In this review, we present data on the epidemiology of NAFLD within Australia, its associated health burden in terms of hepatic and extrahepatic complications, common clinical presentations, and indications for treatment. [ncbi.nlm.nih.gov]

Epidemiology 2nd edn (W. B. Saunders, Philadelphia, 2000). 15 Foster, M. W. & Sharp, R. R. [dx.doi.org]

"The epidemiology of non-alcoholic fatty liver disease". Liver International. 37 : 81–84. doi : 10.1111/liv.13299. PMID 28052624. ^ a b c Angulo P (April 2002). "Nonalcoholic fatty liver disease". [en.wikipedia.org]

Therefore, new pathophysiology directed therapies are urgently needed. [ncbi.nlm.nih.gov]

^ "Fatty Liver: Overview, Pathophysiology, Etiology". 2017-01-25. ^ Buchman AL, Dubin MD, Moukarzel AA, Jenden DJ, Roch M, Rice KM, Gornbein J, Ament ME (November 1995). [en.wikipedia.org]

The endogenously synthesized n-3 PUFAs of the three fat-1 groups, which inhibit fatty acid synthesis and the TLR-4 signaling pathway, prevent HFS diet-induced NAFLD. [ncbi.nlm.nih.gov]

1. Savolainen VT, Liesto K, Männikkö A, Penttilä A, Karhunen PJ. Alcohol consumption and alcoholic liver disease: Evidence of a threshold level of effects of ethanol. Alcohol Clin Exp Res. 1993;17(5):1112-1117.
2. Grant BF, Dufour MC, Harford TC. Epidemiology of alcoholic liver disease. Semin Liver Dis. 1988 Feb;8(1):12-25.
3. Lieber CS. Alcoholic fatty liver: its pathogenesis and mechanism of progression to inflammation and fibrosis. Alcohol. 2004 Aug;34(1):9-19.
4. O'Shea RS, Dasarathy S, McCullough AJ; Practice Guideline Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Alcoholic liver disease. Hepatology. 2010 Jan;51(1):307-328.
5. Wang J, Li P, Jiang Z, et al. Diagnostic value of alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index combined with γ-glutamyl transferase in differentiating ALD and NAFLD. Korean J Intern Med. 2016 May;31(3):479-487.
6. Dunn W, Angulo P, Sanderson S, et al. Utility of a new model to diagnose an alcohol basis for steatohepatitis. Gastroenterology. 2006 Oct;131(4):1057-1063.
7. Uchida T, Kao H, Quispe-Sjogren M, Peters RL. Alcoholic foamy degeneration--a pattern of acute alcoholic injury of the liver. Gastroenterology. 1983 Apr;84(4):683-692.
8. [No authors listed]. Alcoholic liver disease: morphological manifestations. Review by an international group. Lancet. 1981 Mar 28;1(8222):707-711.