Definition, prevalence, and healthcare burden of MetALD - a comprehensive assessment of epidemiology from the east and west

Abstract

Steatotic liver disease (SLD) encompasses a spectrum of liver diseases that span from predominantly metabolic dysfunction-associated SLD, a combination of both metabolic and alcohol-related SLD (MetALD), to those driven predominantly by excessive alcohol use (e.g., alcohol-associated liver disease). The epidemiology of MetALD is not well described and reflects challenges in accurate alcohol consumption reporting and inconsistencies in diagnostic criteria. Existing data estimate the global prevalence of MetALD to range from 2% to 8%, though it is likely underestimated due to variability in alcohol consumption patterns and metabolic risk factors across regions. MetALD is associated with more severe clinical outcomes, including advanced liver fibrosis and increased cardiovascular risk, necessitating early identification and intervention. However, further research is needed that focuses on long-term, population-based studies including objective biomarkers of alcohol consumption, such as phosphatidylethanol, and assessing disease progression using non-invasive methods to accurately categorize disease severity in MetALD. In this review, we provide an update on the epidemiology and healthcare burden of MetALD across Western populations and the Asia-Pacific region.

Keywords

Steatotic liver disease / MetALD / alcohol-associated liver disease / MASLD

References

[1] Ho GJK,Sasikumar NA.High global prevalence of steatotic liver disease and associated subtypes: a meta-analysis.Clin Gastroenterol Hepatol.2025;23:2423-32.e1

[2] Younossi ZM,Price JK.The global epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among patients with type 2 diabetes.Clin Gastroenterol Hepatol.2024;22:1999-2010.e8

[3] Lee BP,Terrault NA.National prevalence estimates for steatotic liver disease and subclassifications using consensus nomenclature.Hepatology.2024;79:666-73 PMCID:11232657

[4] Kalligeros M,Vassilopoulos S,Mylonakis E.Prevalence of steatotic liver disease (MASLD, MetALD, and ALD) in the United States: NHANES 2017-2020.Clin Gastroenterol Hepatol.2024;22:1330-2.e4

[5] Rinella ME,Siddiqui MS.AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease.Hepatology.2023;77:1797-835 PMCID:10735173

[6] Rinella ME, Lazarus JV, Ratziu V, et al.; NAFLD Nomenclature consensus group. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78:1966-86. PMCID:PMC10653297

[7] Gao B,Liangpunsakul S.Metabolic dysfunction and alcohol-associated liver disease (MetALD).eGastroenterology.2025;3:e100319 PMCID:PMC12742176

[8] Yeoh A,Cheung R,Ahmed A.Incidence of cirrhosis and hepatocellular carcinoma among veterans with noncirrhotic metabolic dysfunction-associated fatty liver disease.J Clin Gastroenterol.2024;58:718-25

[9] Wong RJ,Cheung R.Impact of longitudinal alcohol use patterns on long-term risk of cirrhosis among US veterans with steatotic liver disease.Gastroenterology.2024;166:1156-65.e4

[10] Rivera-Esteban J,Higuera M.Phenotypes of metabolic dysfunction-associated steatotic liver disease-associated hepatocellular carcinoma.Clin Gastroenterol Hepatol.2024;22:1774-89.e8

[11] Chen YT,Yang TH.Long-term risks of cirrhosis and hepatocellular carcinoma across steatotic liver disease subtypes.Am J Gastroenterol.2024;119:2241-50 PMCID:PMC11524626

[12] Chen L,Zeng M,Xu L.Clinical and histological features under different nomenclatures of fatty liver disease: NAFLD, MAFLD, MASLD and MetALD.J Hepatol.2024;80:e64-6

[13] Wu T,Mo S.Impact of nomenclature as metabolic associated steatotic liver disease on steatotic liver disease prevalence and screening: a prospective population survey in Asians.J Gastroenterol Hepatol.2024;39:1636-47

[14] Miwa T,Imamura N.Prevalence of steatotic liver disease based on a new nomenclature in the japanese population: a health checkup-based cross-sectional study.J Clin Med.2024;13:1158 PMCID:PMC10888602

[15] Mori K,Tanaka M.Deciphering metabolic dysfunction-associated steatotic liver disease: insights from predictive modeling and clustering analysis.J Gastroenterol Hepatol.2024;39:1382-93

[16] Park HJ,Lee JS.Differences in the prevalence of NAFLD, MAFLD, and MASLD according to changes in the nomenclature in a health check-up using MRI-derived proton density fat fraction.Abdom Radiol.2024;49:3036-44

[17] Lee CM,Kim M.Prevalence, distribution, and hepatic fibrosis burden of the different subtypes of steatotic liver disease in primary care settings.Hepatology.2024;79:1393-400

[18] Choe HJ,Kim W,Cho NH.Steatotic liver disease predicts cardiovascular disease and advanced liver fibrosis: a community-dwelling cohort study with 20-year follow-up.Metabolism.2024;153:155800

[19] Tamaki N,Wakabayashi SI.Long-term clinical outcomes in steatotic liver disease and incidence of liver-related events, cardiovascular events and all-cause mortality.Aliment Pharmacol Ther.2024;60:61-9

[20] Kim A,Choi SC,Sinn DH.Steatotic liver disease and its newly proposed sub-classifications correlate with progression of the coronary artery calcium score.PLoS ONE.2024;19:e0301126 PMCID:PMC10965078

[21] Lee HH,Kim EJ.Metabolic dysfunction-associated steatotic liver disease and risk of cardiovascular disease.Gut.2024;73:533-40

[22] Wong RJ,Sedki M,Singal AK.Estimating steatotic liver disease prevalence among US veterans.Gastro Hep Adv.2025;4:100804 PMCID:PMC12547890

[23] Younossi ZM,Paik JM,Van Dongen C.The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review.Hepatology.2023;77:1335-47 PMCID:10026948

[24] Paik JM,Gupta A,Reyes MA.Prevalence of MASLD, Met-ALD, and ALD and associated fibrosis among US adults: insights from NHANES 2017 to 2023.J Clin Gastroenterol.2025;Epub ahead of print:

[25] Krag A,Younossi ZM.Reporting discrepancy of alcohol intake affecting estimated prevalence of MetALD and ALD.Lancet Gastroenterol Hepatol.2025;10:282-4

[26] Marti-Aguado D,Vilar-Gomez E.Low-to-moderate alcohol consumption is associated with increased fibrosis in individuals with metabolic dysfunction-associated steatotic liver disease.J Hepatol.2024;81:930-40

[27] Männistö V,Jula A.ALT levels, alcohol use, and metabolic risk factors have prognostic relevance for liver-related outcomes in the general population.JHEP Rep.2024;6:101172 PMCID:PMC11489338

[28] Israelsen M,Andersen P.Steatotic liver disease classification is dynamic, affecting clinical trial eligibility and subclass-specific treatments.Clin Gastroenterol Hepatol.2025;23:2509-18

[29] Sedki M,Singal AK.Longitudinal risk of cirrhosis by steatotic liver disease subtype among 1.5 million individuals in the US.JHEP Rep8:101680 PMCID:PMC12907087

[30] Sripongpun P,Udompap P.Characteristics and long-term mortality of individuals with MASLD, MetALD, and ALD, and the utility of SAFE score.JHEP Rep.2024;6:101127 PMCID:PMC11403267

[31] Tampaki M,Lekakis V.Prevalence, characteristics and outcomes of patients with metabolic and alcohol related/associated liver disease (MetALD): a systematic review and meta-analysis.Metabolism.2025;163:156101

[32] Celletti F,De Regil L.World health organization guideline on the use and indications of glucagon-like peptide-1 therapies for the treatment of obesity in adults.JAMA.2026;335:434-8

[33] Alfaris N,Johnson V,Kendrick K.GLP-1 single, dual, and triple receptor agonists for treating type 2 diabetes and obesity: a narrative review.EClinicalMedicine.2024;75:102782 PMCID:PMC11402415

[34] Sanyal AJ, Newsome PN, Kliers I, et al.; ESSENCE Study Group. Phase 3 trial of semaglutide in metabolic dysfunction-associated steatohepatitis. N Engl J Med. 2025;392:2089-99. PMCID:12341575

[35] Hendershot CS,Paladino MB.Once-weekly semaglutide in adults with alcohol use disorder: a randomized clinical trial.JAMA Psychiatry.2025;82:395-405 PMCID:PMC11822619

[36] Subhani M,King JA.Association between glucagon-like peptide-1 receptor agonists use and change in alcohol consumption: a systematic review.EClinicalMedicine.2024;78:102920 PMCID:PMC11701477