The global burden of metabolic and alcohol-associated liver disease (MetALD)

Chronic liver disease is a leading cause of global morbidity and mortality, with an evolving etiologic landscape driven by rising metabolic dysfunction and persistent alcohol use. The introduction of metabolic and alcohol-associated liver disease (MetALD) recognizes the coexistence of these exposures as dual drivers of liver-related outcomes as a distinct clinical entity. This review synthesizes current evidence on the global epidemiology, clinical outcomes, and public health implications of MetALD. Current evidence suggests that ~10%-20% of individuals worldwide with hepatic steatosis meet criteria for MetALD. Emerging data demonstrate that the combination of cardiometabolic risk factors and alcohol is associated with more aggressive liver disease, including accelerated fibrosis progression, increased risk of cirrhosis and hepatic decompensation, and higher incidence of hepatocellular carcinoma compared with either exposure alone. In addition to major adverse liver outcomes, individuals with MetALD experience increased all-cause mortality, reflecting both progressive liver disease and the systemic effects of metabolic dysfunction and alcohol use. These factors contribute substantially to global disability-adjusted life years, particularly among working-age populations. The burden of MetALD varies across regions, reflecting differences in metabolic risk, alcohol consumption, and socioeconomic determinants, and is expected to rise further in both high- and middle-income settings. Despite its growing clinical relevance, the global burden of MetALD remains incompletely characterized due to limitations in standardized definitions, data availability, and ascertainment of alcohol use. Improved recognition, harmonized definitions, and integrated clinical and public health strategies are essential to better characterize and mitigate its impact on global liver health.