Gratacós-Ginès Jordi, Ariño Silvia, Sancho-Bru Pau, Bataller Ramon, Pose Elisa
Liver Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.
JHEP Rep. 2024 Nov 2;7(2):101250. doi: 10.1016/j.jhepr.2024.101250. eCollection 2025 Feb.
Metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD) are the most prevalent causes of chronic liver disease worldwide. Both conditions have many pathophysiological mechanisms in common, such as altered lipid and bile acid metabolism, and share some similar clinical features. Furthermore, metabolic risk factors and alcohol often co-exist in the same individuals and have recently been shown to act synergistically to markedly increase the risk of liver disease. Given the high prevalence and impact of this interaction, steatotic liver disease due to the combination of metabolic dysfunction and moderate-to-high alcohol intake has been termed MetALD in the new steatotic liver disease nomenclature, attracting the interest of the scientific community. Subsequent studies have investigated the prevalence of MetALD, which ranges from 1.7% to 17% in cohorts of patients with steatotic liver disease, depending on the population setting and study design. A few cohort studies have also assessed the prognosis of this patient population, with preliminary data suggesting that MetALD is associated with an intermediate risk of liver fibrosis, decompensation and mortality among steatotic liver disease subtypes. In this review article, we examine the clinical evidence and the experimental models of MetALD and discuss the clinical implications of the term for early detection and management. We provide insight into the pathophysiological mechanisms of the synergistic effect of alcohol and metabolic risk factors, possible screening strategies, the use of biomarkers and emerging models of care, as well as potential therapeutic interventions with a special focus on medications for MASLD, highlighting the most promising drugs for patients with MetALD.
代谢功能障碍相关脂肪性肝病（MASLD）和酒精性肝病（ALD）是全球慢性肝病最常见的病因。这两种疾病有许多共同的病理生理机制，如脂质和胆汁酸代谢改变，并且具有一些相似的临床特征。此外，代谢风险因素和酒精常常在同一个体中共存，最近研究表明它们会协同作用，显著增加肝病风险。鉴于这种相互作用的高患病率和影响，在新的脂肪性肝病命名法中，将代谢功能障碍与中度至高度酒精摄入相结合所致的脂肪性肝病称为代谢性酒精性脂肪性肝病（MetALD），这引起了科学界的关注。随后的研究调查了MetALD的患病率，在脂肪性肝病患者队列中，其患病率在1.7%至17%之间，具体取决于人群背景和研究设计。一些队列研究还评估了该患者群体的预后，初步数据表明，在脂肪性肝病亚型中，MetALD与肝纤维化、失代偿和死亡的中度风险相关。在这篇综述文章中，我们研究了MetALD的临床证据和实验模型，并讨论了该术语对早期检测和管理的临床意义。我们深入探讨了酒精与代谢风险因素协同作用的病理生理机制、可能的筛查策略、生物标志物的使用以及新兴的照护模式，以及潜在的治疗干预措施，特别关注治疗MASLD的药物，强调了对MetALD患者最有前景的药物。
