Alcoholic liver disease: All the risk factors, besides heavy drinking, that lead to liver damage

Symptoms of alcoholic liver disease include abdominal pain, nausea, vomiting, or the presence of fluid in the abdomen called ascites (Representational image)

Are your evenings incomplete without those obligatory shots of whiskey or vodka, accompanied by generous servings of spicy non-vegetarian dishes? Or perhaps you take pride in your role as the official wine connoisseur, indulging in more than a glass a day? Beware, you may be hurtling towards an impending liver damage, and the danger may be closer than you think.

Alcoholic Liver Disease encompasses a range of liver injuries associated with acute and chronic alcoholism. It progresses through three sequential stages: fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. Fatty liver is characterised by the presence of fat vesicles in the liver under microscopic examination, while alcoholic hepatitis occurs when the liver cells become damaged, often following a bout of heavy drinking. Finally, alcoholic cirrhosis occurs as the liver initially enlarges and subsequently shrinks over the course of several years, leading to inflammation and damage.

The small intestine primarily absorbs ethanol (the specific content of alcohol), and an enzyme called alcohol dehydrogenase (ADH) is responsible for initiating its metabolism. Ethanol gets converted to acetaldehyde, a toxic compound that further leads to the formation of acetate (a fatty acid). Alcohol intake escalates the accumulation of triglycerides (the storage form of fatty acids). This hampers the synthesis of protein and certain secretions in the body.

Symptoms of alcoholic liver disease manifest in various ways, including abdominal pain, nausea, vomiting, and the presence of fluid in the abdomen known as ascites. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the onset of jaundice within 60 days of alcohol consumption for a minimum of 6 months is a diagnostic criterion for alcoholic hepatitis.

Following are the risk factors for alcoholic liver cirrhosis, including the obvious - chronic alcohol intake.

1. Alcohol consumption: Chronic alcohol intake is one of the most common contributing factors to liver disease. Fatty liver is observed in over 90 percent of long-term alcohol consumers, eventually progressing to cirrhosis within a decade. Daily consumption of 60-80 gm of ethanol in any form of alcohol over ten years is likely to cause liver damage or cirrhosis. The extent of damage depends on the quantity and duration of alcohol intake rather than the type of alcoholic beverage. Intermittent drinking is better than daily drinking, as it provides a chance for recovery.

2. Female preponderance: Women's increased susceptibility to liver cirrhosis is attributed to the effects of the female sex hormone, estrogen. Even a daily intake of 20-40 gm of ethanol can predispose women to chronic liver damage.

3. Genetics: The rate of alcohol metabolism is based on the genetic framework. The functioning of enzymes such as MEOS (microsomal P450 oxidases) and alcohol dehydrogenase, involved in the conversion of ethanol to carbon dioxide and water, depends on their genetic polymorphism (two or more variants of a DNA sequence).

4. Malnutrition: Malnutrition, characterised by a deficiency of proteins and vitamins, significantly contributes to alcoholic liver disease. Imbalanced dietary habits coupled with alcohol intake create a lethal combination that easily leads to liver damage. Calories derived from alcoholic beverages displace other essential nutrients, particularly vitamins, resulting in various deficiencies.

5. Hepatitis B infection: Persons suffering from Hepatitis B or C have a propensity towards developing alcoholic liver disease, with much less intake, about 20-50 gm/day. The condition can progress rapidly in a lesser amount of time and can also predispose the person to hepatocellular carcinoma (liver cancer).

Insisting on intermittent consumption of alcohol and focusing on a rich and healthy diet with all the essential macro and micro nutrients, along with a go-to stress reliever, can help prevent liver damage. Also, consulting the doctor when you face any symptoms is recommended.