Metabolic Dysfunction and Alcohol-Associated Liver Disease: A Narrative Review

The term steatotic liver disease (SLD) is now used to describe conditions involving fat accumulation in the liver. SLD term includes a spectrum of defined and less defined disorders: metabolic dysfunction-associated SLD (MASLD), alcohol-associated liver disease (ALD), and metabolic and ALD (Met-ALD), where both cardiometabolic risk factors, such as obesity, diabetes, or dyslipidemia, and alcohol consumption function in disease development and progression. Met-ALD is defined as liver disease in men with at least 1 cardiometabolic risk factor who also consume 210-420 g of alcohol per week (approximately 30-60 g per day), whereas for women, it is defined as at least 1 cardiometabolic risk factor in addition to consumption of 140-350 g of alcohol per week (approximately 20-50 g per day). This level of alcohol intake exceeds the thresholds traditionally used to exclude alcohol as a contributing factor in MASLD, but it remains below the levels typically associated with classic ALD. Met-ALD is estimated to affect about 17 million people in the United States It is a unique disease with the risk of cirrhosis, hepatocellular carcinoma, and mortality different from those with MASLD or ALD. Its treatment relies mainly on weight loss, alcohol abstinence, and control of cardiometabolic risk factors. Novel medications such as glucagon-like peptide-1 agonists and fibroblast growth factor s21 analogs may be promising future therapies for the treatment of Met-ALD.