Author information
1Division 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: juanpablo.arab@vcuhealth.org.
2Departamento 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.
3Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, PAHO/WHO Collaborating Centre, Centre for Addiction and Mental Health, Toronto, Canada.
4Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
5Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile.
6Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
7Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
8Department of Internal Medicine, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
9Odense Liver Research Centre, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
10Department of Metabolism, Digestion & Reproduction, Imperial College London, UK.
11Liver Unit, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
12Institute for Social Marketing and Health. University of Stirling, UK.
13Institute of Hepatology Foundation for Liver Research London UK; School of Immunology and Microbial Sciences King's College London, London, UK.
14Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.
15Institute of Pathology, Medical University of Graz, Graz, Austria.
16Division of Gastrointestinal and Liver Diseases, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
17Division of Gastroenterology, Department of Internal Medicine, and Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA.
18Department of Gastroenterology and Hepatology, University of Louisville, Louisville, KY, USA.
19Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
20Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA.
21UCL Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK.
22VA Long Beach Healthcare System - Gastroenterology Section, Long Beach, CA, USA.
23Institute of Liver Studies, Kings College London, London, UK.
24The Roger Williams Institute of Hepatology, Foundation for Liver Research, Kings College London, UK.
25Liver Unit, Regional Institute of Gastroenterology and Hepatology "Octavian Fodor," University of Medicine and Pharmacy "Iuliu Hatieganu," Cluj-Napoca, Romania.
26Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
27CHRU de Lille, Hôpital Claude Huriez, Rue M. Polonovski CS 70001, 59 037 Lille Cedex, France.
28CHRU de Lille, Hôpital Claude Huriez, Rue M. Polonovski CS 70001, 59 037 Lille Cedex, France. Electronic address: philippe.mathurin@chu-lille.fr.
Abstract
This position statement explores the intricate relationship between alcohol intake and metabolic dysfunction in the context of the 2023 nomenclature 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), 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, hypertriglyceridemia, and hyperglycemia. 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 grams for women and 210 grams for men. This is particularly important in those individuals with isolated high blood pressure, hypertriglyceridemia, or hyperglycemia, 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 changes in risk factor exposure. This approach could ensure a more accurate prognosis and effective management of SLD addressing both metabolic and alcohol-related factors.