MetALD: Terminology, Implications, and Therapeutic Considerations

With the introduction of steatotic liver disease (SLD) as an umbrella term and metabolic dysfunction-associated steatotic liver disease (MASLD) as one of its major subcategories, a new diagnostic category was proposed to better reflect the coexistence of metabolic dysfunction and alcohol consumption: MetALD. MetALD identifies individuals with hepatic steatosis and cardiometabolic risk factors whose alcohol intake exceeds MASLD thresholds but remains below the levels typical of alcohol-related liver disease. The prevalence of MetALD in the general population is approximately 4%. Evidence suggests that MetALD is associated with more severe liver-related outcomes and higher all-cause mortality compared to MASLD, although findings are not entirely consistent. Despite these risks, MetALD remains underdiagnosed because alcohol consumption is often self-reported and underestimated due to recall bias, social desirability bias, or stigma. Consequently, managing MetALD requires a multidisciplinary approach addressing both cardiometabolic comorbidities and alcohol-related behavioral factors. MetALD should be viewed not only as a medical condition but also as a disorder with significant behavioral and social dimensions that influence diagnosis, treatment adherence, and long-term outcomes. This review discusses the clinical implications and therapeutic considerations specific to this newly introduced terminology.