World Liver Day: As modern lifestyles evolve, fatty liver disease is emerging as a quiet but growing health concern, with both drinkers and non-drinkers at risk. To shed light on this worrying shift, Firstpost brings you expert insights to explore the reasons behind the trend, why early detection is critical and how lifestyle changes can reverse damage before it’s too late.
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As India witnesses a rising tide of liver-related health concerns, the spotlight is turning toward two major culprits: Alcoholic Fatty Liver Disease (AFLD) and Non-Alcoholic Fatty Liver Disease (NAFLD). Both are increasingly prevalent, often underdiagnosed and potentially life-threatening.
In a conversation with Firstpost, Dr. Rinkesh Kumar Bansal, Additional Director of Gastroenterology at Fortis Memorial Research Institute (Gurugram), discusses the differences between Alcoholic and
Non-alcoholic fatty liver disease, why both demand early attention and how simple lifestyle shifts can prevent irreversible damage.
Alcohol vs. Non-Alcoholic Fatty Liver: Which Is More Dangerous?
Dr Bansal: Fatty liver disease, a condition where fat accumulates in the liver, is becoming increasingly common worldwide. It exists in two primary forms: Alcoholic Fatty Liver Disease (AFLD) and Non-Alcoholic Fatty Liver Disease (NAFLD). While both involve fat buildup, they arise from different causes and carry distinct risks. So, which is more dangerous?
Causes and Risk Factors
Dr Bansal: Alcoholic Fatty Liver Disease (AFLD) is directly caused by excessive alcohol consumption. Long-term drinking overwhelms the liver’s ability to process alcohol, leading to fat accumulation and inflammation.
Non-Alcoholic Fatty Liver Disease (NAFLD), by contrast, affects individuals who consume little to no alcohol. It is commonly associated with obesity, insulin resistance, diabetes, high cholesterol, and metabolic syndrome.
Progression and Severity
Dr Bansal: Both conditions can begin mildly but escalate over time:
AFLD may progress from simple steatosis (fatty liver) to alcoholic hepatitis, and eventually to cirrhosis, severe, irreversible scarring of the liver. Cirrhosis significantly increases the risk of liver failure and liver cancer.
NAFLD can advance to Non-Alcoholic Steatohepatitis (NASH), a more serious stage involving liver inflammation and damage. Like AFLD, NASH can lead to cirrhosis and liver cancer.
In terms of progression, AFLD can worsen more rapidly, especially if alcohol consumption continues. NAFLD generally progresses more slowly, but because it’s often silent and linked to chronic conditions like diabetes, it may go unnoticed until reaching an advanced stage.
Prevalence and Awareness
Dr Bansal: NAFLD is more prevalent, affecting up to 25% of the global population. It’s increasingly seen in younger individuals due to rising obesity rates. AFLD is less common but remains a major concern, particularly among people with alcohol use disorders.
A major challenge with NAFLD is that it is often underdiagnosed, as it can remain asymptomatic for years. AFLD is usually detected earlier due to its association with alcohol and more visible warning signs.
Which Is More Dangerous?
Dr Bansal: There is no simple answer. AFLD tends to be more acutely dangerous, particularly in cases of binge drinking or long-term alcohol abuse, where liver damage can progress rapidly and severely.
NAFLD, on the other hand, presents a broader and more long-term threat due to its increasing prevalence and links to chronic conditions such as heart disease, the leading cause of death in NAFLD patients.
Treatment and Outlook
Dr Bansal: For AFLD, the most effective treatment is complete cessation of alcohol. If addressed early, the liver has a strong capacity to heal.
Key interventions for NAFLD include lifestyle modifications such as weight loss, a healthy diet, and regular exercise. Managing diabetes, cholesterol, and blood pressure is also essential.
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