"Five Decades On: metALD Emerges as Liver Disease's New Frontier".

This year marks the 50th anniversary of the American Liver Foundation (ALF). Over the five ensuing decades since its inception, the ALF has advocated for and advanced research and public awareness in liver disease. The rise and subsequent improvement of viral hepatitis prevalence during this time contrasts with rising incidence of alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease (MASLD). Moreover, the concomitant actions of alcohol toxicity in context of metabolic liver disease are now recognized as metabolic and alcohol-related liver disease (metALD). This unique and more rapidly progressive form of liver disease has thus emerged as one of liver disease's new frontiers. Here, we highlight a few key findings recently published in CMGH, and underscore new mechanistic insights into the metabolic drivers, alcohol toxicity, and their synergy in progressive liver pathophysiology.