Alcoholic liver disease and its relationship with metabolic syndrome

Alcoholic liver disease (ALD), which occurs from chronic excessive drinking, progresses from initial alcoholic fatty liver to more advanced type such as alcoholic hepatitis, liver fibrosis, or liver cirrhosis when habitual drinking continues. In general, chance of liver cirrhosis increases after 20 years of chronic heavy drinking, but liver cirrhosis can occur in women after a shorter period of habitual drinking at a lower amount of alcohol. Alcoholic liver cirrhosis accounts for approximately 20% of all liver cirrhosis cases. The key treatment is abstinence or substantial cutting down on drinking; the prognosis is poor if the patient continues drinking after being diagnosed with liver cirrhosis. Factors that exert adverse effects on the progression of ALD include gender difference, presence of hepatitis virus, immunologic abnormality, genetic polymorphism of alcohol-metabolizing enzymes, and complication of obesity or overweight. Recently, particular attention has been paid to obesity and overweight as risk factors in the progression of ALD. Conditions such as visceral fat accumulation, obesity, and diabetes mellitus underlie the pathologic factor of metabolic syndrome (MetS). In liver, MetS may accompany fatty liver or steatohepatitis, with possible progression to liver cirrhosis in some cases. Caution is required for patients with MetS who have a high alcohol intake because alcohol consumption further accelerates the progression of liver lesions.