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Abstract Background/Purpose: A new disease name, "Steatotic Liver Disease (SLD)" was proposed, along with new diagnostic criteria for metabolic dysfunction in 2023. Within this context, metabolic associated steatotic liver disease (MASLD) with increased alcohol intake (MetALD) was named as a new specific subgroup. The clinical profiles and outcomes of MetALD patients are unknown. Methods Participants included in the Taiwan Biobank database were selected. Patients positive for HBsAg, anti-HCV, and former drinkers were excluded. MASLD was diagnosed if having hepatic steatosis on ultrasound, plus at least one of cardiometabolic criteria. Increased alcohol intake was defined as alcohol consumption exceeding 210 grams for males and 140 grams for females weekly. The FIB-4 score was used to assess the degree of liver fibrosis, and carotid plaques on duplex ultrasound were employed to diagnose atherosclerosis. Results In a total of 18,160 (mean age 55.28 ± 10.41; 33.2% males) participants, there were 7,316 (40.3%) MASLD patients and 209 (1.2%) MetALD patients. The participants with increased alcohol intake were younger and male predominant. After propensity score matching for age and gender, MetALD patients had higher AST, GGT, fatty liver index (FLI), and FIB-4 score and tended to have a higher proportion of carotid plaques than MASLD patients. Among MASLD patients, those with moderate alcohol intake had higher values of GGT, FLI, and FIB-4 score and a higher proportion of carotid plaques than those with no or social alcohol intake. Conclusions This population-based cohort study indicates that MetALD patients have a higher risk of liver injury than those with MASLD. Moreover, modest alcohol intake also increases the risk of liver injury and atherosclerotic in MASLD patients, suggesting MASLD patients should refrain from alcohol intake.
Wang et al. (Tue,) studied this question.