MetALD: Clinical aspects, pathophysiology and treatment

Area of Science:

• Hepatology and Gastroenterology
• Metabolic and Liver Diseases
• Toxicology and Pharmacology

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD) are leading causes of chronic liver disease globally.
• Common pathophysiological pathways, including lipid and bile acid metabolism, link MASLD and ALD.
• Co-existing metabolic risk factors and alcohol consumption synergistically elevate liver disease risk.

Purpose of the Study:

• To review clinical evidence and experimental models of MetALD (steatotic liver disease from metabolic dysfunction and alcohol).
• To discuss the clinical implications of the MetALD term for early detection and management.
• To explore pathophysiological mechanisms, screening, biomarkers, and therapeutic interventions for MetALD.

Main Methods:

• Review of existing clinical evidence and experimental models related to MetALD.
• Analysis of prevalence data from cohort studies (1.7%–17% in steatotic liver disease populations).
• Assessment of preliminary prognostic data from cohort studies on MetALD outcomes.

Main Results:

• MetALD is a recognized entity in new liver disease nomenclature, reflecting the combined impact of metabolic dysfunction and alcohol.
• Prevalence varies significantly based on population and study design.
• Preliminary data suggest MetALD is associated with intermediate risks of fibrosis, decompensation, and mortality.

Conclusions:

• Understanding MetALD is crucial given the synergistic interaction between metabolic factors and alcohol.
• Further research into screening, biomarkers, and targeted therapies, including MASLD medications, is warranted.
• The term MetALD facilitates focused research and clinical attention on this prevalent liver condition.