Metabolic Impact of Alcohol Consumption in MASLD: Understanding MetALD and Beyond

Steatotic liver disease (SLD) is a condition with a high prevalence worldwide. Moreover, systemic metabolic impairments have also risen, creating a dangerous combination that negatively impacts liver-related and overall mortality. Additionally, a substantial increase in alcohol consumption has been observed over the last decade, which also significantly affects mortality. Recently, a new category of SLD has been defined for patients with SLD and a specific pattern of alcohol consumption, named metabolic and alcohol-associated hepatic steatosis (MetALD). The combined liver damage in these patients is devastating. Evidence has demonstrated that MetALD patients present a higher risk of hepatic disease progression and mortality. Despite these observations, a recommendation for alcohol consumption has not been established. Assessing alcohol intake remains a challenge due to underreporting, lack of standardized detection methods, and a strong social stigma. The effect of alcohol consumption on liver disease progression has been widely discussed in literature. However, current evidence shows that alcohol intake poses more risks for metabolically unhealthy individuals, and nowadays there is no safe recommended alcohol dose for them. The new concept of MetALD highlights the synergistic effect of metabolic dysfunction and alcohol consumption on the progression of liver disease, worsening metabolic liver disease outcomes. The integration of MetALD into clinical practice emphasizes the need for evidence that elucidates the effect of this disease on each metabolic impairment, highlighting the implementation of targeted public health policies aimed at reducing alcohol consumption, optimizing patient care, and improving liver disease outcomes.