Alcoholic fatty liver

Non-alcoholic fatty liver disease begins with asymptomatic fatty liver but may progress to cirrhosis. This is a disease of exclusion elimination of any possible viral, genetic, or environmental causes must be made prior to making this diagnosis. Non-alcoholic fatty liver disease is related to numerous metabolic abnormalities. Risk factors include diabetes mellitus, dyslipidemia, obesity, and other conditions associated with increased hepatic fat.26... 

Athyros VG, Mikhailidis DP, Didangelos TP, Giouleme OI, Liberopoulos EN, Karagiannis A et al. Effect of multifactorial treatment on non-alcoholic fatty liver disease in metabolic syndrome a randomised study. Cur Med Res Opin 2006 22(5) 873-83. 

Except for one case/° recent clinically oriented MRS studies of human liver have been at 1.5T. Several studies applied in vivo MRS to diffuse liver disease. ° °" The PDE intensity was lower in cirrhosis than in controls ° and served to distinguish the alcoholic, viral, and cholestatic etiologies of diffuse liver disease. ° However, there was no difference between patients with non-alcoholic fatty liver disease (NAFLD) and controls. Sharma et al., using the relative PME intensity as a measure of altered gluconeogenesis (this peak can contain glucose-6-P and 3-phos-phoglycerate in addition to PC and PE), found that hepatic gluconeogenesis was altered in both obese and non-obese Asian Indians with NAFLD, relative to non-obese subjects without NAFLD. 

Liver disease is the most common medical complication of alcohol abuse an estimated 15-30% of chronic heavy drinkers eventually develop severe liver disease. Alcoholic fatty liver, a reversible condition, may progress to alcoholic hepatitis and finally to cirrhosis and liver failure. In the United States, chronic alcohol abuse is the leading cause of liver cirrhosis and of the need for liver transplantation. The risk of developing liver disease is related both to the average amount of daily consumption and to the duration of alcohol abuse. Women appear to be more susceptible to alcohol hepatotoxicity than men. Concurrent infection with hepatitis or C virus increases the risk of severe liver disease. 

You M, Crabb DW Recent advances in alcoholic liver disease II. Minireview Molecular mechanisms of alcoholic fatty liver. Am J Physiol Gastrointest Liver Physiol 2004 287 G1. 

The use of metformin in patients with non-alcoholic fatty liver disease has been reported in two trials (123,124). Patients had abnormal liver function tests, which improved during the studies. No-one withdrew because of worsening of liver function tests or lactic acidosis. 

Bugianesi E, Gentilcore E, Manini R, Natale S, Vanni E, Villanova N, David E, Rizzetto M, Marchesini G. A randomised controlled trial of metformin versus vitamin E or prescriptive diet in non-alcoholic fatty liver disease. Am J Gastroenterol 2005 100 1082-90. 

Non-alcoholic fatty liver disease (NAFID) and non-alcoholic steatohepatitis (NASH)... 

Liver disease is now recognised as a major complication of type 2 diabetes. Diabetes mellitus can lead to metabolic changes that alter normal hepatic and biliary function and structure. Type 2 diabetes is associated with an increased risk of a range of hepatobiliary diseases, including non-alcoholic fatty liver disease, cirrhosis, acute liver failure, hepatocellular carcinoma and cholelithiasis [22]. 

Anfossi G, Massucco P, Bonomo K, Trovati M (2004) Prescription of statins to dyslipidemic patients affected by liver diseases a subtle balance between risks and benefits. Nutr Metab Cardiovasc Dis 14 215-224. Gomez-Dominguez E, Gisbert J, Moreno-Monteagudo J, Garcia-Buey L, Moreno-Otero R (2006) A pilot study of atorvastatin treatment in dys-lipemid, non-alcoholic fatty liver patients. Aliment Pharmacol Ther 23 1643-1647. 

Alcoholic foamy degeneration is considered to be a variant of alcoholic fatty liver (T. Uchida et al., 1983). There is evidence of microvesicular steatosis, giant mitochondria, focal cell necrosis (with elevation of GPT, GOT and GDH) and cholestasis (with increase of AP and sometimes of bilirubin), whereas inflammatory alterations are rare and Mallory bodies totally absent. Likewise, there is no sign of fever or leucocytosis. (133)... 

A severe cholestatic syndrome (H. Ballard et al., 1961) can be observed in patients suffering from alcoholic fatty liver, (s. fig. 28.16) The clinical picture may correspond to that of obstructive jaundice and cause great problems in differential diagnosis, particularly because such patients may not have been known before to be suffering from alcohol-induced liver disease. Extremely severe forms to the point of acute liver failure have been observed. 

The prognosis for alcoholic fatty liver is good when abstention is uncompromisingly maintained, and complete reversibility can be expected within a few weeks or months. In contrast, alcoholic hepatitis has a fatal outcome in 10-20% of cases. When alcohol consumption is continued, about 40% of patients develop cirrhosis, while some 60% persist for several years. However, when alcohol abstention is maintained, only 15-20% of cases develop cirrhosis, some 50-60% persist for up to 3 years, and 20-30% recover completely. Half of the persistent cases normalize again. There is a five-year survival rate in 50-70% of patients (depending on severity), with the mortality rate remaining almost constant after the third year. In alcoholic cirrhosis, the two-year mortality rate can reach 85% with continued alcohol consumption, but falls to 10% with strict abstention. (2)... 

Zieve, L. Jaundice, hyperlipidemia and hemolytic anemia a heretofore unrecognized syndrome associated with alcoholic fatty liver and cirrhosis. Ann. Intern. Med. 1958 48 471—496... 

Non-alcoholic fatty liver disease 579 10 Carbohydrate storage diseases 595... 

Causes of fatty liver are manifold, and combinations of causes quite common. Acquired causes are by far the most frequent, but there are also rare causes, e.g. coeliac disease (9, 25), parenteral nutrition. (28, 29) Congenital metabolic disorders can also lead to the development of a fatty liver, as in the case of a rare thesaurismosis. It is of considerable therapeutic and prognostic importance to differentiate between an alcoholic fatty liver (AFL) and alcoholic steatohepatitis (ASH) (s. pp 529, 531) as well as between non-alcoholic fatty liver (NAFLD) and non-alcoholic steatohepatitis (NASH). (2, 20, 24, 36) (s. tabs. 31.5-31.7)... 

Angelico, F., del Ben, M., Conti, R., Francioso, S., Feole, K., Maccioni, D., Antonini, T.M., Alessandri, C. Non-alcoholic fatty liver syndrome a hepatic consequence of common metabolic diseases. J. Gastroenterol. Hepatol. 2003 18 588-594... 

A. J. Non-alcoholic fatty liver disease in patients with type 2 diabetes. Clin. Gastroenterol. Hepatol. 2004 2 262—265... 

Zafrani, E.S. Non-alcoholic fatty liver disease an emerging pathological spectrum. Virch. Arch. 2003 444 3-12... 

Tarantino G, Conca P, Basile V, et al. A prospective study of acute drug-induced liver injury in patients suffering from non-alcoholic fatty liver disease. Hepatol Res. 2007 37(6) 410-415. 

There is no question that alcohol abuse contributes significantly to liver-related morbidity and mortality in the United States. Long-term alcohol use is the leading cause of illness and death from liver disease. There are three phases of alcohol-induced liver damage, alcoholic fatty liver, which is usually reversible with abstinence alcoholic hepatitis or inflammation and alcoholic cirrhosis or scarring of the liver. Patients with both alcoholic cirrhosis and hepatitis have a death rate of more than 60% over a 4-year period. The prognosis is bleaker than the outlook for many types of cancers. As many as 900 000 people in the United States suffer from cirrhosis and some 26 000 of these die each year. The risk for liver disease is related to how much a person drinks the risk is low at levels of alcohol consumption but steeply increases with higher levels of consumption. Because effects of alcohol are dose-related and because of the steepness at which the adverse effects are... 

Lieber CS.. Alcoholic fatty liver Its pathogenesis and mechanism of progression to inflammation and fibrosis. Alcohol2004 34(1) 9 19. 

Includes alcoholic fatty liver, chronic persistent hepatitis. 

NADH is also a product inhibitor of enzymes in the pathway that oxidizes fatty acids. Consequently, these fatty acids accumulate in the liver, eventually contributing to the alcoholic fatty liver. 

Abidov, M., Ramazanov, Z., Seifulla, R., and Grachev, S. (2010). The effects of Xanthigen in the weight management of obese premenopausal women with non alcoholic fatty liver disease and normal liver fat. Diabetes Obes. Metab. 12,72-81. 

Leamy AK, Egnatchik RA, Young JD (2013) Molecular mechanisms and the role of saturated fatty acids in the progression of non-alcoholic fatty liver disease. Prog Lipid Res 52, 165-74. 

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