From NAFLD to MASLD and MetALD: Conceptual Shifts in Metabolic Liver Disease and Their Implications for Mexico.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is now recognized as the leading cause of chronic liver disease worldwide. The updated terminology reflects a conceptual shift by emphasizing metabolic dysfunction rather than excluding alcohol consumption. This redefinition introduced MetALD, a subtype characterized by the coexistence of cardiometabolic risk factors and moderate alcohol intake. In the world, misclassification of MetALD as MASLD is frequent, often due to underreporting of alcohol consumption, which may distort epidemiological estimates. In Mexico, where both obesity and alcohol use are highly prevalent, this reclassification carries important implications for diagnosis, prognosis, and public health policy. This review summarizes the current evidence on MASLD and MetALD, highlighting their prevalence, diagnostic challenges, and implications for liver transplantation and cancer surveillance. We advocate for integrating these diseases into national non-communicable disease policies and adopting a multidisciplinary, preventive approach tailored to the Mexican context.