Metabolic dysfunction and alcohol-associated liver disease (MetALD)

Metabolic dysfunction and alcohol-associated liver disease (MetALD) is a recently implemented nomenclature and disease terminology for patients with metabolic dysfunction-associated steatotic liver disease, who consume greater amounts of alcohol. MetALD is diagnosed in individuals who have at least one metabolic risk factor (such as obesity, type 2 diabetes mellitus, hypertension, etc) and consume 140-350 g/week of alcohol for women or 210-420 g/week for men. Conversely, alcohol-associated liver disease is diagnosed in individuals who consume >350 g/week of alcohol for women and >420 g/week for men. MetALD represents a heterogeneous spectrum of liver disease, with variations in clinical presentation and severity driven by differences in metabolic profiles, drinking patterns and individual susceptibility. Alcohol and metabolic risk factors are thought to act synergistically to accelerate steatohepatitis, fibrosis and hepatocellular carcinoma. However, the precise mechanisms underlying liver injury in MetALD still remain poorly understood. In this comprehensive review, we summarise the current definition, diagnostic criteria and clinical management of MetALD. We also discuss emerging insights into understanding its pathogenesis, examine relevant experimental models and highlight future challenges and research priorities in this evolving field.