Alcoholic fatty liver disease is a liver disease caused by long-term and excessive alcohol consumption. It is a type of alcoholic liver disease. It has a history of long-term drinking, generally more than 5 years, with an equivalent amount of ethanol of ≥40g/d for men and ≥20g/d for women, or a history of large amounts of drinking in the past 2 weeks, with an equivalent amount of ethanol >80g/d, but attention should be paid to the influence of factors such as gender and genetic susceptibility. The formula for converting ethanol amount (g) = drinking volume (m1) × ethanol content (%) × 0.8. Clinical symptoms are non-specific, can be asymptomatic, or have upper right abdominal distension, loss of appetite, fatigue, weight loss, and meet the following clinical diagnostic criteria for alcoholic liver disease, such as imaging diagnosis meets the criteria for fatty liver, and serum ALT, AST, or GGT have only slight abnormalities, it can be diagnosed as alcoholic fatty liver in the alcoholic liver disease. Clinical diagnostic criteria for alcoholic liver disease:
1. Have a long history of alcohol consumption, generally more than 5 years, equivalent to at least 40g/d of ethanol for men, or at least 20g/d for women, or a history of excessive alcohol consumption within 2 weeks, equivalent to more than 80g/d of ethanol. However, it is important to consider the influence of factors such as gender and genetic susceptibility. The conversion formula for ethanol amount (g) = alcohol consumption (ml) x ethanol content (%) x 0.8.
2. Clinical symptoms are non-specific, can be asymptomatic, or have upper right abdominal pain, loss of appetite, fatigue, weight loss, jaundice, etc.; with the progression of the disease, there may be neurological and psychiatric symptoms, as well as spider veins, and palmoplantar erythema.
3. The levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transferase (GGT), total bilirubin (TBil), prothrombin time (PT), mean corpuscular volume (MCV), and desglycophosphatidylserine (CDT) are elevated. Among them, AST/ALT > 2, GGT elevation, and MCV elevation are characteristics of alcoholic liver disease, while CDT determination is relatively specific but not routinely conducted in clinical practice. After quitting drinking, these indicators can significantly decrease, usually returning to normal within 4 weeks (but GGT recovery is slower), which is helpful for diagnosis.
4. Liver ultrasound or CT examination shows typical signs.
4. Exclude active infection of hepatotropic viruses, drug-induced liver injury, and autoimmune liver disease, etc. Those who meet the first, second, third, and fifth items or the first, second, and fourth items and the fifth item can be diagnosed with alcoholic liver disease; those who only meet the first, second, and fifth items can be suspected of having alcoholic liver disease.
1. What are the causes of alcoholic fatty liver disease?
There are many factors that can affect the progression or exacerbation of alcoholic liver injury, and the risk factors identified in foreign research in China include: alcohol consumption, drinking years, type of alcoholic beverage, drinking method, gender, race, obesity, hepatitis virus infection, genetic factors, nutritional status, and so on. According to epidemiological survey data, liver injury caused by alcohol has a threshold effect, that is, once a certain amount of alcohol consumption or drinking years is reached, the risk of liver damage will increase significantly. However, due to significant individual differences, some studies also show that the dose-effect relationship between alcohol consumption and liver damage is not very clear. There are many types of alcoholic beverages, and different types of alcoholic beverages can cause different degrees of liver damage. Drinking method is also a risk factor for alcoholic liver injury; drinking on an empty stomach is more likely to cause liver damage than drinking with meals. Women are more sensitive to alcohol-mediated liver toxicity; compared to men, smaller doses and shorter drinking periods may lead to more severe alcoholic liver disease. The blood alcohol levels in men and women are significantly different when consuming the same amount of alcoholic beverages.
Race, genetics, and individual differences are also important risk factors for alcoholic liver disease. The allele frequencies and genotype distributions of the alcohol dehydrogenase (ADH)2, ADH3, and aldehyde dehydrogenase (ALDH)2 genes in the Han population are different from those in Western countries, which may be one of the reasons why the incidence of alcoholism and alcoholic liver disease in the Chinese drinking population is lower than that in Western countries. Not all drinkers will develop alcoholic liver disease, but it occurs in a small part of the population, indicating that there are also individual differences among the same regional population. The increasing mortality rate of alcoholic liver disease is related to the degree of malnutrition. Deficiency of vitamin A or a decrease in vitamin E levels may also worsen liver damage. A diet rich in polyunsaturated fatty acids can promote the progression of alcoholic liver disease, while saturated fatty acids have a protective effect on alcoholic liver disease. Obesity or overweight can increase the risk of the progression of alcoholic liver disease. Hepatitis virus infection has a synergistic effect on liver damage caused by alcohol, and drinking alcohol on the basis of hepatitis virus infection, or the occurrence of HBV or HCV infection on the basis of alcoholic liver disease, can accelerate the occurrence and development of liver disease.
2. What complications are easily caused by alcoholic fatty liver
In addition to liver damage, alcoholic hepatitis is also prone to cause some complications:
1, Hepatic encephalopathy
It is the most serious complication of the disease and also the most common cause of death.
2, Upper gastrointestinal bleeding
Esophageal variceal bleeding is common, often causing hemorrhagic shock or triggering hepatic encephalopathy.
3, Hepatorenal syndrome
Manifested by oliguria or anuria, azotemia, hyponatremia, and hypouricemia.
4, Alcoholic ketoacidosis
Related to alcohol consumption and malnutrition, manifested by nausea, vomiting, dehydration, hyperventilation, fruity breath, ketonuria, hyperketonemia, and hyperglycemia.
5, Zieve syndrome
The triad is characterized by jaundice, hyperlipidemia, and hemolysis, which is more common in men over 40, often occurring after acute alcohol consumption, and manifested as loss of appetite, nausea, vomiting, diarrhea, severe abdominal pain, and other symptoms.
6, Portal hypertension
Can be caused by the compression of hepatic sinusoids and hepatic veins by a large amount of fat deposition.
7, Hepatopulmonary syndrome
Manifested as melena, cyanosis, clubbing, hypoxemia.
8, Infection
Spontaneous bacterial peritonitis is common, and skin, respiratory, gastrointestinal, and urinary tract infections may also occur.
5. What laboratory tests are needed for alcoholic fatty liver disease
For those who meet the clinical diagnostic criteria of alcoholic liver disease, such as those who meet the criteria for fatty liver according to imaging diagnosis, and whose serum ALT, AST, or GGT only have slight abnormalities, they can be diagnosed as alcoholic fatty liver disease. The clinical diagnostic criteria for alcoholic liver disease are:
1. Have a long history of alcohol consumption, generally more than 5 years, equivalent to at least 40g/d of ethanol for men, or at least 20g/d for women, or a history of excessive alcohol consumption within 2 weeks, equivalent to more than 80g/d of ethanol. However, it is important to consider the influence of factors such as gender and genetic susceptibility. The conversion formula for ethanol amount (g) = alcohol consumption (ml) x ethanol content (%) x 0.8.
2. Clinical symptoms are non-specific, can be asymptomatic, or have upper right abdominal pain, loss of appetite, fatigue, weight loss, jaundice, etc.; with the progression of the disease, there may be neurological and psychiatric symptoms, as well as spider veins, and palmoplantar erythema.
3. The levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transferase (GGT), total bilirubin (TBil), prothrombin time (PT), mean corpuscular volume (MCV), and desglycophosphatidylserine (CDT) are elevated. Among them, AST/ALT > 2, GGT elevation, and MCV elevation are characteristics of alcoholic liver disease, while CDT determination is relatively specific but not routinely conducted in clinical practice. After quitting drinking, these indicators can significantly decrease, usually returning to normal within 4 weeks (but GGT recovery is slower), which is helpful for diagnosis.
4. Liver ultrasound or CT examination shows typical signs.
4. Exclude active infection of hepatotropic viruses, drug-induced liver injury, and autoimmune liver disease, etc. Those who meet the first, second, third, and fifth items or the first, second, and fourth items and the fifth item can be diagnosed with alcoholic liver disease; those who only meet the first, second, and fifth items can be suspected of having alcoholic liver disease.
6. Dietary taboos for alcoholic fatty liver disease patients
1. Abstain from Alcohol
Alcoholic fatty liver disease patients should strictly quit drinking. Quitting drinking can be considered a key premise for the treatment of alcoholic fatty liver disease. Timely quitting drinking plays a very crucial role in preventing and blocking the further development of the disease and improving the prognosis. At the same time, it can also effectively recover and improve the damaged liver. Therefore, quitting drinking for alcoholic fatty liver disease patients is undoubtedly necessary.
2. Pay attention to the diversity of diet
Alcoholic liver disease patients should increase rather than decrease the variety of daily food, and avoid dietary monotony. Since the nutritional components contained in various foods are not entirely the same, relying solely on a few types of food cannot fundamentally meet the nutritional needs of alcoholic liver disease patients. Therefore, a balanced diet is necessary for fruits and vegetables, grains, legumes, dairy products, and fungal food products, which can be very helpful in preventing malnutrition that is easily caused by alcoholic liver disease.
3. Pay attention to sufficient amounts of high-quality protein
Patients with alcoholic fatty liver should pay attention to a moderate intake of high-protein diet, as surveys have found that dietary protein nutrition is related to the effect of alcohol liver. Long-term drinking and liver fattyization are easy to lead to protein-energy malnutrition, so attention should be paid to the intake of high-quality protein in diet, which is not only helpful for the repair and regeneration of liver cells, but also very beneficial for the recovery of alcoholic fatty liver.
4. Pay attention to the intake of multiple vitamins
Patients with alcoholic fatty liver should pay attention to the intake of multiple vitamins, trace elements, essential amino acids, and minerals, as surveys have found that alcoholic fatty liver is often accompanied by vitamin deficiency and other malnutrition. Therefore, attention should be paid to effective supplementation in diet, which is beneficial for enhancing the liver cells' tolerance to hypoxia, promoting the excretion of triglycerides, and the metabolism of lipids.
7. Conventional methods of Western medicine for the treatment of alcoholic fatty liver
1. Abstain from Alcohol
Abstaining from alcohol is the most important measure for the treatment of alcoholic fatty liver, and attention should be paid to the prevention and treatment of withdrawal syndrome during the process of abstaining from alcohol.
2. Nutritional Support
Patients with alcoholic fatty liver need good nutritional support, and high-protein, low-fat diet should be provided on the basis of abstinence from alcohol, and attention should be paid to the supplementation of vitamins B, C, K, and folic acid.
3. Drug Treatment
If serum ALT, AST, or GGT levels are slightly elevated, drug treatment can be considered. S-adenosylmethionine therapy can improve the clinical symptoms and biochemical indicators of patients with alcoholic fatty liver. Phosphatidylcholine has a tendency to prevent histological deterioration in patients with alcoholic fatty liver. Glycyrrhizin preparations, silymarin, phosphatidylcholine, and reduced glutathione, among other drugs, have varying degrees of antioxidant, anti-inflammatory, and protective effects on the liver cell membrane and organelles, and clinical application can improve liver biochemical indicators.
4. Alcoholic Liver Disease
The liver of patients often has pathological changes such as liver fibrosis, so attention should be paid to antifibrotic treatment. There are many traditional Chinese medicine preparations or formulas for antifibrotic treatment at present.
