MetALD: decoding the evolution of steatotic liver disease nomenclature and implications for clinical practice and beyond

Abstract The steatotic liver disease (SLD) landscape has seen a paradigm shift in recent years with a revitalization of the nomenclature following a multi-society Delphi consensus. The terms metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) were introduced to address several of the challenges and limitations associated with the former terminology. By transitioning away from stigmatizing and ambiguous terms, the nomenclature has adopted inclusionary language that emphasizes the underlying risk factors that drive disease progression and are accompanied by distinct diagnostic criteria. With SLD prevalence steadily increasing over the past few decades, affecting over 30% of the global population, accurate classification of the spectrum of conditions that fall under this overarching term is essential. Most importantly, the introduction of combined metabolic and alcohol-associated liver disease (MetALD) as a novel subclassification of SLD has shifted the diagnostic approach, raised awareness of disease prevalence, and paved the way for therapeutic management and multidisciplinary approaches to patient care. By recognizing the distinct clinical entity that is MetALD and the synergistic interplay between the cardiometabolic risk factors and alcohol use, clinicians are better equipped to effectively care for this patient population. In this review, we aim to discuss the catalysts for the SLD nomenclature changes, the dynamic nature of its subclasses, the natural history and disease burden, and the implications for clinical practice and research, with a particular focus on MetALD.