Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are among the most common causes of chronic liver disease in developing and the developed world. Easy availability of alcohol and sedentary lifestyle have contributed to the increased incidence of these diseases. NAFLD represents a spectrum of liver disease, including fatty liver (NAFL) which is considered a benign disease, steatohepatitis (NASH) which suggests ongoing injury to liver and cirrhosis. ALD also represents a spectrum comprising of simple steatosis, alcoholic hepatitis, and cirrhosis and its complications.

Often, there is a significant overlap between these diseases and the clinical presentation is based on the stage of liver disease. Most NAFLD patients are asymptomatic and are diagnosed as having fatty liver on routine health check-up. ALD is associated with a significant history of alcohol intake, supported by radiological and biochemical tests.

In both the conditions, liver enzymes are rarely elevated more than five times the upper limit of normal. Establishing the diagnosis of NASH requires liver biopsy as it is a histological diagnosis. It may be needed in alcoholic hepatitis occasionally to confirm if the diagnosis is doubtful.

Source: Sharma P, Arora A. Clinical presentation of alcoholic liver disease and non-alcoholic fatty liver disease: spectrum and diagnosis. Transl Gastroenterol Hepatol. 2020 Apr 5;5:19.