Metabolic dysfunction and alcohol-related liver disease (MetALD): Position statement by an expert panel on alcohol-related liver disease.

Sven M Francque, Alexandre Louvet, Philippe Mathurin, Robyn Burton, Ramon Bataller, Horia Stefanescu, Patrick S Kamath, Ashwani K Singal, Aleksander Krag, Jürgen Rehm, Timothy R Morgan, Brian P Lee, Jessica Mellinger, Mark Thursz, Shilpa Chokshi, Craig MacClain, Pranoti Mandrekar, Gene Im, Luis Antonio Díaz, Michael R Lucey, Nick Sheron, Debbie Shawcross, Maja Thiele, Marsha Y Morgan, Suthat Liangpunsakul, Eric Trépo, Carolin Lackner, Elisa Pose, Vijay H Shah, Norah Terrault, Christophe Moreno, Marco Arrese, Juan Pablo Arab, Mack C Mitchell

Journal: Journal of hepatology 2025;82(4):744-756

PMID: 39608457

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Abstract

In this position statement, we explore the intricate relationship between alcohol intake and metabolic dysfunction in the context of the 2023 nomenclature update for steatotic liver disease (SLD). Recent and lifetime alcohol use should be accurately assessed in all patients with SLD to facilitate classification of alcohol use in grams of alcohol per week. Alcohol biomarkers (i.e., phosphatidylethanol), use of validated questionnaires (i.e. AUDIT-C [alcohol use disorders identification test consumption]), and collateral information from friends and relatives could help facilitate differentiation between alcohol-related liver disease (ALD) per se and liver disease with both metabolic and alcohol-related components (MetALD). Heavy alcohol use can contribute to cardiometabolic risk factors such as high blood pressure, hypertriglyceridaemia, and hyperglycaemia. As a result, caution should be exercised in the application of only one metabolic dysfunction criterion to diagnose MASLD, as suggested in the 2023 nomenclature document, particularly in individuals exceeding weekly alcohol use thresholds of 140 g for women and 210 g for men. This is particularly important in those individuals with isolated high blood pressure, hypertriglyceridaemia, or hyperglycaemia, where the disease process may be driven by alcohol itself. Additionally, metabolic dysfunction and alcohol use should be reassessed over time, especially after periods of change in risk factor exposure. This approach could ensure a more accurate prognosis and effective management of SLD, addressing both metabolic and alcohol-related factors.

Address: Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA; Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile. Electronic address: [email protected].; Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile; MASLD Research Center, Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, CA, USA.; Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, PAHO/WHO Collaborating Centre, Centre for Addiction and Mental Health, Toronto, Canada.; Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile.; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.; Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.; Department of Internal Medicine, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.; Odense Liver Research Centre, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.; Department of Metabolism, Digestion & Reproduction, Imperial College London, UK.; Liver Unit, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.; Institute for Social Marketing and Health. University of Stirling, UK.; Institute of Hepatology Foundation for Liver Research London UK; School of Immunology and Microbial Sciences King's College London, London, UK.; Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.; Institute of Pathology, Medical University of Graz, Graz, Austria.; Division of Gastrointestinal and Liver Diseases, University of Southern California Keck School of Medicine, Los Angeles, California, USA.; Division of Gastroenterology, Department of Internal Medicine, and Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA.; Department of Gastroenterology and Hepatology, University of Louisville, Louisville, KY, USA.; Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.; Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA.; UCL Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK.; VA Long Beach Healthcare System - Gastroenterology Section, Long Beach, CA, USA.; Institute of Liver Studies, Kings College London, London, UK.; The Roger Williams Institute of Hepatology, Foundation for Liver Research, Kings College London, UK.; Liver Unit, Regional Institute of Gastroenterology and Hepatology "Octavian Fodor," University of Medicine and Pharmacy "Iuliu Hatieganu," Cluj-Napoca, Romania.; Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.; CHRU de Lille, Hôpital Claude Huriez, Rue M. Polonovski CS 70001, 59 037 Lille Cedex, France.; CHRU de Lille, Hôpital Claude Huriez, Rue M. Polonovski CS 70001, 59 037 Lille Cedex, France. Electronic address: [email protected].

DOI: 10.1016/j.jhep.2024.11.028