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

Abstract

Abstract: The term Steatotic Liver Disease is now used to describe conditions involving fat accumulation in the liver. Steatotic Liver Disease term includes a spectrum of defined and less defined disorders; Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD), Alcohol-associated Liver Disease (ALD), and Metabolic and Alcohol-Associated Liver Disease (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 one cardiometabolic risk factor who also consume 210-420 grams of alcohol per week (approximately 30-60 grams per day), while for women, it is defined as at least one cardiometabolic risk factors in addition to consumption of 140-350 grams of alcohol per week (approximately 20-50 grams 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 US. It is a unique disease with 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-21 analogs may be promising future therapies for the treatment of MetALD.