title: Alcoholic liver disease presents at advanced stage and progresses faster compared to non-alcoholic fatty liver diseas.
abstract: OBJECTIVE
  Steatohepatitis is a common cause of liver disease due to alcohol (ALD) or non-alcoholic fatty liver disease (NAFLD). We performed this study to compare natural history of ALD and NAFLD.
  
  
  METHODS
  Retrospective analysis of ALD or NAFLD patients managed at our center (2007-2011). ALD diagnosed by excluding other liver diseases (except HCV) and alcohol abuse of > 40 g/d in women and > 60 g/d in men for > 5 years. NAFLD diagnosed by excluding other liver diseases and a history of alcohol use of < 10 g/d. Cirrhosis was diagnosed using biopsy for uncertain clinical diagnosis.
  
  
  RESULTS
  Compared to patients with NAFLD (n = 365; mean age 50 yrs; 43% males; 53% diabetic), ALD patients (n = 206; mean age 51 yrs; 68% males; 24% diabetic) presented more often with cirrhosis or complications(46vs. 12%; P< 0.0001) with a higher MELD score (13 ± 7 vs. 8 ± 8; P<0.0001). On logistic regression, ALD diagnosis was associated with presence of cirrhosis by over 4-fold (4.1 [1.8-9.1]) even after excluding 23 patients with concomitant HCV. Over median follow up of about 3 and 4 yrs among ALD and NAFLD patients respectively, ALD patients more frequently developed cirrhosis or its complications including HCC with worse transplant free survival (90 vs. 95%; P = 0.038).
  
  
  CONCLUSIONS
  Compared to NAFLD, ALD patients present at an advanced stage of liver disease with a faster progression on follow-up. Prospective multicenter studies are needed to identify potential barriers to early referral of ALD patients as basis for development of strategies to improve outcome of patients with ALD.
authors: Division of Gastroenterology and Hepatology.
authors: Mohamed
authors: M
authors: Shoreibah
authors: Department of Internal Medicine, UAB, Birmingham, AL, USA.
authors: Evan
authors: E
authors: Raff
authors: Division of Gastroenterology and Hepatology.
authors: Joseph
authors: J
authors: Bloomer
authors: Division of Gastroenterology and Hepatology.
authors: Donny
authors: D
authors: Kakati
authors: Department of Internal Medicine, UAB Montgomery Program, Montgomery, AL, USA.
authors: Khalid
authors: K
authors: Rasheed
authors: Department of Biostatistics, UTMB, Galveston, TX, USA.
authors: Yong-Fang
authors: YF
authors: Kuo
authors: Division of Gastroenterology and Hepatology.
authors: Ashwani K
authors: AK
authors: Singal
mesh_terms: D000328:Adult; D015897:Comorbidity; D018450:Disease Progression; D005235:Fatty Liver, Alcoholic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D008104:Liver Cirrhosis, Alcoholic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index