MetALD at the crossroads of metabolic and alcohol-related liver disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease (ALD) are leading causes of global liver morbidity. Addressing the complex interplay of metabolic and alcohol-related factors has led to the 'MetALD' (metabolic dysfunction and alcohol-associated liver disease) concept, categorizing individuals with metabolic dysfunction who consume alcohol beyond MASLD thresholds but below ALD criteria. MetALD is associated with increased mortality and severe liver outcomes, including accelerated progression to advanced fibrosis, cancer, and cardiovascular complications. Accurate diagnosis requires precise alcohol quantification; novel biomarkers, particularly blood phosphatidylethanol, effectively address this by overcoming the frequent underreporting of ethanol intake. This review provides an overview of MetALD diagnostic and management strategies, emphasizing the need for integrated therapeutic approaches to improve patient outcomes.