Alcoholic fatty liver disease (AFLD) Home A-Z Health Information Health Library A-Z Alcoholic Fatty Liver Disease (AFLD) Overview Alcoholic fatty liver disease (AFLD) is the earliest stage of ALD, and is characterised by abnormal hepatic accumulation of fat (steatosis) in response to alcohol consumption; such a liver generally appears light yellow in colour. AFLD. Importantly, it can progress to more severe liver conditions, such as alcoholic steatohepatitis, liver fibrosis, cirrhosis, and liver cancer. Causes and risk factors Chronic alcohol abuse is the primary cause of AFLD. Other factors include: Genetic factors: Some people are genetically predisposed to developing AFLD due to differences in how their liver metabolises alcohol or their ability to tolerate alcohol-related damage.Nutritional deficiencies: Malnutrition and poor diet—often associated with chronic alcohol use (heavy and prolonged)—can accelerate liver damage and increase the risk of AFLD.Obesity: Overweight individuals are at higher risk of developing AFLD.Other liver diseases: People with pre-existing liver conditions (like hepatitis B or C infection) are more susceptible to developing AFLD.Age and gender: The risk of developing AFLD increases with age, and women may be more susceptible to AFLD than men, even with lower levels of alcohol consumption.Other health conditions: Diabetes, high cholesterol, and high blood pressure may increase the risk of developing AFLD. Symptoms In the early stages, AFLD may exhibit no symptoms (asymptomatic) or very mild symptoms. As the condition progresses, more symptoms can manifest; these include:Fatigue: Feeling unusually tired or lethargic.Pain or discomfort in the upper right abdomen: This generally observed as the upper right abdomen is the place where the liver is located.Enlarged liver (hepatomegaly): The liver may become palpable (feel enlarged) upon examination.Jaundice and dark urine: These conditions can occur in more advanced stages of AFLD, when the liver loses its ability to process bilirubin.Loss of appetite: Reduced desire to eat.Nausea and vomiting: These are often seen in more advanced liver disease.Most people with AFLD do not exhibit symptoms until the disease progresses to more serious stages, such as alcoholic steatohepatitis. Diagnosis The first stage of diagnosis includes a full review of the patient’s medical history, including alcohol consumption patterns and assessment of liver disease signs and any pre-existing conditions, like diabetes or obesity. Other diagnostic strategies have been enumerated below.Physical examination: This involves checking for liver enlargement or tenderness.Blood tests: A multitude of blood tests are available for diagnosing AFLD; these include,Liver function tests: Elevated ALT and AST levels can indicate liver injury; however, these tests are not specific to AFLD.Alcoholic biomarkers: Elevated GGT levels and mean corpuscular volume (MCV) may indicate alcohol-related liver damage; however, these are not specific to AFLD.Complete blood count (CBC): CBC can help detect signs of liver dysfunction (e.g., low platelet counts), including AFLD.Imaging techniques: A variety of imaging techniques can be used to detect liver damage, including AFLD.Ultrasound: This non-invasive test can assess fat accumulation in the liver.CT or MRI: These can provide more detailed images of the liver and detect fat deposits.Elastography: This specialised ultrasound technique can measure liver stiffness, which can indicate liver damage.Liver biopsy: In some cases, liver biopsy may be used to confirm the presence of fat in the liver and assess the degree of liver damage. Biopsies are typically done when the diagnosis is uncertain or to rule out other liver diseases. Treatment Abstinence from alcohol is the cornerstone of AFLD treatment. Continuing to drink alcohol can worsen the liver damage, and AFLD can progress to more severe conditions, like alcoholic steatohepatitis and cirrhosis. The treatment and management modalities of AFLD include:Support for cessation of alcohol consumption: Programs, therapy, or medications (such as disulfiram or naltrexone) may be prescribed to help individuals stop drinking.Nutritional and lifestyle changes: A few dietary and lifestyle changes can help manage AFLD.Proper nutrition: A healthy, balanced diet rich in vitamins, minerals, and antioxidants can support liver health and improve outcomes.Weight loss: Gradual weight loss (5‒10% of the body weight) can help reduce liver fat and improve liver function, especially in individuals with obesity.Avoiding fatty foods: Reducing the consumption of saturated fats and processed foods can help lower the liver’s fat load.Managing underlying conditions: Management of pre-existing conditions can also help manage AFLD.Diabetes: Proper management of blood glucose levels can help prevent further liver damage.High cholesterol levels: Lowering the cholesterol levels with medications like statins may help protect the liver.High blood pressure: Controlling blood pressure with medications can reduce the strain on the liver.Medications: Currently, there are no medications specifically approved for AFLD; however, some studies suggest that vitamin E may help reduce liver inflammation in individuals with AFLD (especially non-diabetic individuals). Prevention The most effective way to prevent AFLD is to reduce or eliminate alcohol intake. Other preventive measures include:Maintaining a healthy weight: Obesity contributes to the development of fatty liver disease, so maintaining a healthy weight can reduce the risk of AFLD.Eating a balanced diet: Avoiding excessive fats and sugars, and focusing on a nutritious diet rich in fruits, vegetables, lean proteins, and whole grains can help manage AFLD.Exercising regularly: Physical activity helps manage weight and improves liver health.Monitoring and managing underlying conditions: Proper management of diabetes, high cholesterol levels, and high blood pressure can reduce the strain on the liver and help prevent AFLD.