Steatotic Liver Disease: Metabolic Dysfunction, Alcohol, or Both?

Abstract

Non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease (ALD), both of them accounting for fatty liver disease (FLD), are among the most common chronic liver diseases globally, contributing to substantial public health burden. Both NAFLD and ALD share a similar picture of clinical presentation yet may have differences in prognosis and treatment, which renders early and accurate diagnosis difficult but necessary. While NAFLD is the fastest increasing chronic liver disease, the prevalence of ALD has seemingly remained stable in recent years. Lately, the term steatotic liver disease (SLD) has been introduced, replacing FLD to reduce stigma. SLD represents an overarching term to primarily comprise metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), as well as alcohol-related liver disease (ALD), and MetALD, defined as a continuum across which the contribution of MASLD and ALD varies. The present review discusses current knowledge on common denominators of NAFLD/MASLD and ALD in order to highlight clinical and research needs to improve our understanding of SLD.

Keywords: alcohol-related liver disease (ALD); metabolic dysfunction-associated steatohepatitis (MASH); metabolic-dysfunction associated steatotic liver disease (MASLD); non-alcoholic fatty liver disease (NAFLD); steatotic liver disease (SLD).

Figure 1

Survival of patients with ALD by SALVE fibrosis stage (SFS) (adapted from [31]).

Figure 2

Potential therapeutic targets for NASH (from [37]; with copyright permission).