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Nonalcoholic fatty liver disease and alcohol-related liver disease together, compose the majority of
cases of liver disease and cirrhosis worldwide. Although in the last years, there has been much interest in the
differentiation between the two entities, it is increasingly recognized that a large overlap exists between them.
The main pathophysiological aspects are very similar, with the exceptions of mechanisms directly related to alcohol,
acting as an added factor in the presence of metabolic risk factors. Genetic factors so far identified are also
very similar. In both cases, the disease is more prevalent in males, the difference being more significant in the
ALD group, having to do with harmful alcohol consumption, which is more frequent in males. NAFLD advanced
stages usually present in older age than ALD.
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Regarding laboratory features, the ratio AST/ALT < 1 is more frequent in NAFLD than ALD, in the absence of
cirrhosis. Histological aspects of both situations are very similar, but some are specific for ALD, such as alcoholic
foamy degeneration or cholestasis, or fibroobliterative venous lesions. Regarding treatment, several drugs now
included in clinical trials in NAFLD, could also be assayed in ALD, since similar mechanisms of action, are
potentially acting in ALD. In summary, similarities seem to outnumber differences, and since so large overlap
between risk factors exist, the use of a common designation such as Fatty Liver Disease (FLD) or Metabolic Fatty
Liver disease (MEFLD), could better serve the field.
Oxidative Stress and Nonalcoholic Fatty Liver Disease in Hemodialysis Patients
