Alcoholic Fatty Liver Disease (AFLD)

Alcoholic fatty liver disease (AFLD) happens when too much fat builds up the liver of a person who drinks alcohol heavily over a long period of time. It can progress through three major phases:

  1. Alcohol-induced fatty liver – All livers contain some fat, but the liver’s normal fat level is 5 to 10 percent. A person with AFLD can have additional fatty deposits in the liver, causing the liver to become enlarged. (For information on fatty liver disease not caused by alcohol use, check out our summary of nonalcoholic fatty liver disease (NAFLD).
  2. Alcoholic hepatitis – If AFLD progresses to this second stage, the liver becomes inflamed. As the liver tries to heal itself, it leaves behind scar tissue. If too much scar tissue builds up, it leads to the final stage of AFLD.
  3. Liver cirrhosis – When there is too much scar tissue, the liver can no longer work properly, destroying liver function. This is called cirrhosis of the liver.

A person can have both NAFLD and AFLD at the same time.


AFLD often has no symptoms, although a person may notice upper abdominal tenderness on the right side, fatigue, weakness, and weight loss.

Symptoms of alcoholic hepatitis include:

  • Jaundice, which is yellowing of the skin and the whites of the eyes
  • Pain in the upper-right side of the abdomen
  • Low-grade fever
  • Weakness
  • Nausea and vomiting
  • Loss of appetite

Liver cirrhosis symptoms can also include an enlarged spleen, malnutrition, intestinal bleeding, fluid buildup in the belly, kidney or liver failure, confusion, and liver cancer.

Risk Factors

AFLD is caused by heavy alcohol use over time, although not everyone who drinks heavily will develop AFLD. Additional conditions that can contribute to AFLD or make AFLD worse are hepatitis C and malnutrition. Other risk factors for AFLD include:

  • Drinking heavily for a long period of time
  • Having certain genetic factors
  • Being overweight or obese
  • Being a woman
  • Being Black or Hispanic
  • Binge drinking

When to See a Doctor

If you have any symptoms of AFLD, make an appointment with your doctor for a thorough exam and consultation. Early detection, diagnosis, and treatment can prevent your condition from getting worse.

If you want to control your drinking but are having trouble cutting back on alcohol, you are not alone. Your doctor can help connect you with support, resources, and treatments that can help you.

Treatment Options

If you have AFLD, the first and most important thing to do is to stop drinking alcohol. Your doctor may also recommend diet or medication changes. Your AFLD treatment plan may include:

  • Treatment for symptoms of alcohol withdrawal
  • Medical detoxification from alcohol
  • Nutritional support
  • Recovery programs for alcohol addiction
  • Treatment for AFLD complications
  • Liver transplant

Diagnostic Testing

The foremost diagnostic test for any condition is a thorough exam and consultation with a physician, including a review of your individual and family history. In addition, your physician may recommend any of the following tests or procedures, which may provide further diagnostic value:


AFLD is a preventable condition. The most important thing to do is to avoid alcohol, or to drink alcohol only in moderation. Also, pay attention to medications you’re taking that may affect your liver. Finally, seek treatment for other liver conditions, like hepatitis C, that could make AFLD worse.

Learn More

Learn more about AFLD with resources from the National Institutes of Health.

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