World Liver Day 2025: Causes, symptoms and differences between alcoholic and non-alcoholic fatty liver disease

Alcoholic vs non-alcoholic fatty liver: Obesity, poor diabetes control, and sedentary lifestyles are the most common cause of cirrhosis and liver cancer everywhere. Indians, in particular, have a higher tendency for central obesity, making them more vulnerable to MASLD (Image: Canva)

Fatty liver disease occurs when too much fat builds up in the liver. It’s normal for the liver to have a little bit of fat, but when more than 5–10 percent of the liver’s weight is fat, it’s considered a fatty liver, or steatosis.

According to the American Liver Foundation, when this buildup is not caused by alcohol, it’s called nonalcoholic fatty liver disease (NAFLD) — now renamed metabolic dysfunction-associated steatotic liver disease (MASLD).

The more serious form of this condition is known as nonalcoholic steatohepatitis (NASH), or metabolic dysfunction-associated steatohepatitis (MASH). In MASH, the fat buildup causes inflammation and damage to the liver, which can lead to serious complications over time.

Also read | Fatty liver disease in young adults: Symptoms, causes, preventive measures to keep in mind

Causes of fatty liver diseases: Men who drink more than 2–3 drinks a day and women who consume more than 1–2 are especially at risk. Even these amounts may be unsafe for those with other risk factors like obesity or hepatitis B/C (Image: Canva)

MASLD is quickly becoming the most common cause of cirrhosis and liver cancer everywhere, says Dr Pankaj Puri, Director - Gastroenterology and Hepatobiliary Sciences, Fortis Escorts, New Delhi. “Obesity, poor diabetes control, and sedentary lifestyles are driving this silent epidemic. Indians, in particular, have a higher tendency for central obesity, making them more vulnerable to MASLD,” he says.

Dangers of alcoholic fatty liver disease:

Alcoholic fatty liver remains a serious public health challenge, especially in those with long-term, heavy alcohol consumption. “Up to 90 percent of people with significant alcohol intake will develop fatty liver. Later, this may progress into alcoholic hepatitis, cirrhosis, and even liver cancer,” informs Dr Puri.

Men who drink more than 2–3 drinks a day and women who consume more than 1–2 are especially at risk. “Even these amounts may be unsafe for those with other risk factors like obesity or hepatitis B/C. Common signs, such as an enlarged liver, red palms, and spider-like blood vessels on the chest, may only appear once serious damage has already occurred. While stopping alcohol consumption is crucial, combining it with lifestyle changes may help improve outcomes,” he warns.

Also read | Fatty liver disease: Here's what you should know to prevent obesity, diabetes, metabolic disorders

Dr Puri shares the differences, and similarities, between alcoholic and non-alcoholic fatty liver disease:

• Root cause: Alcoholic fatty liver is caused by excessive alcohol intake. While MASLD (formerly NAFLD) is triggered by metabolic factors like obesity, diabetes, and poor lifestyle, even without alcohol.

• Progression risk: Both types can lead to inflammation, fibrosis, cirrhosis, and liver cancer if not addressed early.

• Symptoms: Fatty liver disease is usually silent. Symptoms like fatigue, abdominal discomfort, or jaundice often appear only in advanced stages.

• Diagnosis: Ultrasound is a common first-line test, but Dr Puri recommends a Fibroscan for more accurate detection. “Liver function tests and enzyme levels (AST, ALT) are also key indicators, especially elevated AST in alcoholic cases," he says.

• Treatment approach: For alcoholic fatty liver, a complete abstinence from alcohol is essential. Amd for MASLD, weight loss, improved blood sugar control, and exercise are the primary treatments. In both cases, medications should be taken only under medical supervision.

• Prevention tips: Exercise regularly (at least 45 minutes, five times a week). Eat a protein-rich, liver-friendly diet including fish, eggs, pulses, and paneer. Last, but not the least, avoid self-medication and monitor liver health annually.