Hispanics may develop alcoholic liver disease at an earlier age than whites or blacks, according to a new study that links ethnicity and drinking-related liver problems

Hispanics may develop alcoholic liver disease at an earlier age than whites or blacks, according to a new study that links ethnicity and drinking-related liver problems.Alcoholic liver disease (ALD) includes conditions such as alcoholic fatty liver, alcoholic hepatitis and alcoholic cirrhosis. It's is a common cause of liver problems in the United States. ALD is responsible for more than 15,000 U.S. deaths each year, according to the researchers.

58. Verily! Allah commands that you should render back the trusts to those, to whom they are due; and that when you judge between men, you judge with justice. Verily, how excellent is the teaching which He (Allah) gives you! Truly, Allah is Ever All-Hearer, All-Seer.

59. O you who believe! Obey Allah and obey the Messenger (Muhammad ), and those of you (Muslims) who are in authority. (And) if you differ in anything amongst yourselves, refer it to Allah and His Messenger (), if you believe in Allah and in the Last Day. That is better and more suitable for final determination. 

60. Have you seen those (hyprocrites) who claim that they believe in that which has been sent down to you, and that which was sent down before you, and they wish to go for judgement (in their disputes) to the Taghut (false judges, etc.) while they have been ordered to reject them. But Shaitan (Satan) wishes to lead them far astray.

61. And when it is said to them: "Come to what Allah has sent down and to the Messenger (Muhammad )," you (Muhammad ) see the hypocrites turn away from you (Muhammad ) with aversion.

62. How then, when a catastrophe befalls them because of what their hands have sent forth, they come to you swearing by Allah, "We meant no more than goodwill and conciliation!"

63. They (hypocrites) are those of whom Allah knows what is in their hearts; so turn aside from them (do not punish them) but admonish them, and speak to them an effective word (i.e. to believe in Allah, worship Him, obey Him, and be afraid of Him) to reach their innerselves.

64. We sent no Messenger, but to be obeyed by Allah's Leave. If they (hypocrites), when they had been unjust to themselves, had come to you (Muhammad ) and begged Allah's Forgiveness, and the Messenger had begged forgiveness for them: indeed, they would have found Allah All-Forgiving (One Who accepts repentance), Most Merciful.

65. But no, by your Lord, they can have no Faith, until they make you (O Muhammad ) judge in all disputes between them, and find in themselves no resistance against your decisions, and accept (them) with full submission.4. Surah An-Nisa' (The Women)

"The findings in this study are important for two reasons. First, they demonstrate the difference ethnicity has on the clinical manifestation of ALD. Second, they lay the ground work for future clinical and laboratory studies to understand the interactions between alcohol, genes and the environment," Christopher Bowlus said in a journal news release.

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Bowlus, acting chief of the division of gastroenterology and hepatology at UC Davis Health System in California, cautioned: "No one should feel that they are free from ALD.There is a risk you will develop serious ALD. If you are Hispanic, you should be particularly concerned because you may be at even greater risk of serious liver damage from alcohol."

For the study, the researchers reviewed the medical records of almost 800 ALD patients treated at the University of California, Davis Medical Center between 2002 and 2010.

This study is the first to show that Hispanics seem to develop ALD at a younger age than other races. The study found that Hispanics are diagnosed with ALD between four and 10 years younger than whites and blacks, according to study author Valentina Medici, associate professor of internal medicine at UC Davis Health System.

"In addition, alcoholic Hispanics tend to be more frequently obese and diabetic than the other ethnicities. Also, Hispanics with alcoholic cirrhosis were more likely to be hospitalized than Caucasians, indicative of a possibly more severe disease," she added in the news release.

Even when ALD patients with obesity and diabetes were excluded from the analysis, Hispanics were still younger than whites, which suggests "Hispanics have most likely many risk factors that contribute to the development of their liver disease," Medici said.

Alcohol-Related Liver Disease

Explore this section to learn more about the ways in which alcohol affects the liver and how alcohol-induced liver disease is diagnosed and treated.

Why is the liver important?

The liver is the second largest organ in your body and is located under your rib cage on the right side. It weighs about three pounds and is shaped like a football that is flat on one side.


The liver performs many jobs in your body. It processes what you eat and drink into energy and nutrients your body can use. The liver also removes harmful substances from your blood.

How does alcohol affect the liver?

Alcohol can damage or destroy liver cells.

The liver breaks down alcohol so it can be removed from your body. Your liver can become injured or seriously damaged if you drink more alcohol than it can process.

What are the different types of alcohol-related liver disease?

There are three main types of alcohol-related liver disease: alcoholic fatty liver disease, alcoholic hepatitis, and alcoholic cirrhosis.

Alcoholic fatty liver disease
Alcoholic fatty liver disease results from the deposition of fat in liver cells. It is the earliest stage of alcohol-related liver disease. There are usually no symptoms. If symptoms do occur, they may include fatigue, weakness, and discomfort localized to the right upper abdomen. Liver enzymes may be elevated, however tests of liver function are often normal. Many heavy drinkers have fatty liver disease. Alcoholic fatty liver disease may be reversible with abstinence of alcohol.

Alcoholic hepatitis
Alcoholic hepatitis is characterized by fat deposition in liver cells, inflammation and mild scarring of the liver. Symptoms may include loss of appetite, nausea, vomiting, abdominal pain, fever and jaundice. Liver enzymes are elevated and tests of liver function may be abnormal. Up to 35 percent of heavy drinkers develop alcoholic hepatitis and of these 55% already have cirrhosis.

Alcoholic hepatitis can be mild or severe. Mild alcoholic hepatitis may be reversed with abstinence. Severe alcoholic hepatitis may occur suddenly and lead to serious complications including liver failure and death.

Alcoholic cirrhosis
Alcoholic cirrhosis, the most advanced type of alcohol induced liver injury is characterized by severe scarring and disruption of the normal structure of the liver -- hard scar tissue replaces soft healthy tissue. Between 10 and 20 percent of heavy drinkers develop cirrhosis. Symptoms of cirrhosis may be similar to those of severe alcoholic hepatitis. Cirrhosis is the most advanced type of alcohol-related liver disease and is not reversed with abstinence. However, abstinence may improve the symptoms and signs of liver disease and prevent further damage.

How does alcohol-related liver disease progress?

Many heavy drinkers will progress from fatty liver disease to alcoholic hepatitis to alcoholic cirrhosis over time. However, some heavy drinkers may develop cirrhosis without first having alcoholic hepatitis first. Others may have alcoholic hepatitis but never have symptoms. Additionally, alcohol consumption may worsen liver injury caused by non-alcoholic liver diseases such as chronic hepatitis C.

Since an individual's susceptibility to the toxic effects of alcohol may vary by many factors including age, gender, genetics and coexistent medical conditions, it is reaspnable for you to review alcohol use with your physician.

What are the complications of alcohol-related liver disease?

Complications from alcohol-related liver disease usually occur after years of heavy drinking. These complications can be serious.

They may include liver related conditions that are a consequence of portal hypertension:

• build up of fluid in the abdomen

• bleeding from veins in the esophagus or stomach

• enlarged spleen

• brain disorders and coma

• kidney failure

• liver cancer

In addition alcoholic liver disease may be accompanied by multi-organ non-liver conditions.

How is alcohol-related liver disease diagnosed?

Alcohol-related liver disease may be suspected based on a person's history of alcohol abuse, laboratory or radiologic abnormalities or medical conditions related to alcohol abuse. Blood tests may be used to rule out other liver diseases. Your doctor also may need to do a liver biopsy. During a biopsy, a small piece of liver tissue is removed and studied in the lab.

How is alcohol-related liver disease treated?

Treatment for alcohol-related liver disease requires a healthy diet including avoiding alcohol. Your doctor may suggest changes in your diet to help your liver recover from the alcohol-related damage. Treatment may require you to participate in an alcohol recovery program. Medications may be needed to manage the complications caused by your liver damage. Individuals with advanced alcoholic liver disease that does not improve with abstinence and medical management may benefit from a liver transplant.

Nonalcoholic steatohepatitis or NASH is a common, often “silent” liver disease. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. Most people with NASH feel well and are not aware that they have a liver problem. Nevertheless, NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly.

NASH affects 2 to 5 percent of Americans. An additional 10 to 20 percent of Americans have fat in their liver, but no inflammation or liver damage, a condition called “fatty liver.” Although having fat in the liver is not normal, by itself it probably causes little harm or permanent damage. If fat is suspected based on blood test results or scans of the liver, this problem is called nonalcoholic fatty liver disease (NAFLD). If a liver biopsy is performed in this case, it will show that some people have NASH while others have simple fatty liver.

Both NASH and NAFLD are becoming more common, possibly because of the greater number of Americans with obesity. In the past 10 years, the rate of obesity has doubled in adults and tripled in children. Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH. Diabetes and high blood cholesterol are also becoming more common among Americans.

Biliary system.

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Diagnosis

NASH is usually first suspected in a person who is found to have elevations in liver tests that are included in routine blood test panels, such as alanine aminotransferase (ALT) or aspartate aminotransferase (AST). When further evaluation shows no apparent reason for liver disease (such as medications, viral hepatitis, or excessive use of alcohol) and when x rays or imaging studies of the liver show fat, NASH is suspected. The only means of proving a diagnosis of NASH and separating it from simple fatty liver is a liver biopsy. For a liver biopsy, a needle is inserted through the skin to remove a small piece of the liver. NASH is diagnosed when examination of the tissue with a microscope shows fat along with inflammation and damage to liver cells. If the tissue shows fat without inflammation and damage, simple fatty liver or NAFLD is diagnosed. An important piece of information learned from the biopsy is whether scar tissue has developed in the liver. Currently, no blood tests or scans can reliably provide this information.

Liver biopsy.

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Symptoms

NASH is usually a silent disease with few or no symptoms. Patients generally feel well in the early stages and only begin to have symptoms—such as fatigue, weight loss, and weakness—once the disease is more advanced or cirrhosis develops. The progression of NASH can take years, even decades. The process can stop and, in some cases, reverse on its own without specific therapy. Or NASH can slowly worsen, causing scarring or “fibrosis” to appear and accumulate in the liver. As fibrosis worsens, cirrhosis develops; the liver becomes seriously scarred, hardened, and unable to function normally. Not every person with NASH develops cirrhosis, but once serious scarring or cirrhosis is present, few treatments can halt the progression. A person with cirrhosis experiences fluid retention, muscle wasting, bleeding from the intestines, and liver failure. Liver transplantation is the only treatment for advanced cirrhosis with liver failure, and transplantation is increasingly performed in people with NASH. NASH ranks as one of the major causes of cirrhosis in America, behind hepatitis C and alcoholic liver disease.

Stages of liver damage.

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Causes

Although NASH has become more common, its underlying cause is still not clear. It most often occurs in persons who are middle-aged and overweight or obese. Many patients with NASH have elevated blood lipids, such as cholesterol and triglycerides, and many have diabetes or prediabetes, but not every obese person or every patient with diabetes has NASH. Furthermore, some patients with NASH are not obese, do not have diabetes, and have normal blood cholesterol and lipids. NASH can occur without any apparent risk factor and can even occur in children. Thus, NASH is not simply obesity that affects the liver.

While the underlying reason for the liver injury that causes NASH is not known, several factors are possible candidates:

• insulin resistance
• release of toxic inflammatory proteins by fat cells (cytokines)
• oxidative stress (deterioration of cells) inside liver cells

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Treatment

Currently, no specific therapies for NASH exist. The most important recommendations given to persons with this disease are to

• reduce their weight (if obese or overweight)
• follow a balanced and healthy diet
• increase physical activity
• avoid alcohol
• avoid unnecessary medications

These are standard recommendations, but they can make a difference. They are also helpful for other conditions, such as heart disease, diabetes, and high cholesterol.

A major attempt should be made to lower body weight into the healthy range. Weight loss can improve liver tests in patients with NASH and may reverse the disease to some extent. Research at present is focusing on how much weight loss improves the liver in patients with NASH and whether this improvement lasts over a period of time.

People with NASH often have other medical conditions, such as diabetes, high blood pressure, or elevated cholesterol. These conditions should be treated with medication and adequately controlled; having NASH or elevated liver enzymes should not lead people to avoid treating these other conditions.

Experimental approaches under evaluation in patients with NASH include antioxidants, such as vitamin E, selenium, and betaine. These medications act by reducing the oxidative stress that appears to increase inside the liver in patients with NASH. Whether these substances actually help treat the disease is not known, but the results of clinical trials should become available in the next few years.

Another experimental approach to treating NASH is the use of newer antidiabetic medications—even in persons without diabetes. Most patients with NASH have insulin resistance, meaning that the insulin normally present in the bloodstream is less effective for them in controlling blood glucose and fatty acids in the blood than it is for people who do not have NASH. The newer antidiabetic medications make the body more sensitive to insulin and may help reduce liver injury in patients with NASH. Studies of these medications—including metformin, rosiglitazone, and pioglitazone—are being sponsored by the National Institutes of Health and should answer the question of whether these medications are beneficial in NASH.

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Hope through Research

What is most needed in the management of NASH is more research to better understand the liver injury found in this disease. When the pathways that lead to the injury are fully known, safe and effective means can be developed to reverse these pathways and help patients with NASH. Recent breakthroughs in mapping the human genome and uncovering the individual steps by which insulin and other hormones regulate blood glucose and fat could provide the necessary clues.

The National Institute of Diabetes and Digestive and Kidney Diseases funds the NASH Clinical Research Network, which comprises eight clinical centers located throughout the United States and a coordinating center at Johns Hopkins University. The NASH network researches the nature and underlying cause of NASH and conducts clinical studies on prevention and treatment. More information on the NASH Clinical Research Network and the locations of the clinical centers are available atjhuccs1.us/nash .

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Points to Remember

• Nonalcoholic steatohepatitis (NASH) is fat in the liver, with inflammation and damage.
• NASH occurs in people who drink little or no alcohol and affects 2 to 5 percent of Americans, especially people who are middle-aged and overweight or obese.
• NASH can occur in children.
• People who have NASH may feel well and may not know that they have a liver disease.
• NASH can lead to cirrhosis, a condition in which the liver is permanently damaged and cannot work properly.
• Fatigue can occur at any stage of NASH.
• Weight loss and weakness may begin once the disease is advanced or cirrhosis is present.
• NASH may be suspected if blood tests show high levels of liver enzymes or if scans show fatty liver.
• NASH is diagnosed by examining a small piece of the liver taken through a needle, a procedure called biopsy.
• People who have NASH should reduce their weight, eat a balanced diet, engage in physical activity, and avoid alcohol and unnecessary medications.
• No specific therapies for NASH exist. Experimental therapies being studied include antioxidants and antidiabetes medications.