Distinct Laboratory and Clinical Features of Metabolic and Alcohol-Related Liver Disease (MetALD): A Systematic Review and Meta-Analysis

We aimed to perform a systematic review and meta-analysis of observational studies, primarily to compare laboratory findings, including liver function tests, and metabolic parameters, between patients with Metabolic and alcohol-related/associated liver disease (MetALD) and those with metabolic dysfunction-associated steatotic liver disease (MASLD) or alcohol-related liver disease (ALD). MetALD is a newly recognized subtype of steatotic liver disease (SLD) characterized by the synergistic impact of metabolic dysfunction and alcohol consumption. Data on its clinical and laboratory profile remain limited. Thirty-three studies including 7,504,674 individuals were analyzed. Compared to MASLD, MetALD was associated with higher aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), higher triglycerides (TG) and high density lipoprotein-cholesterol (HDL-C), lower low density lipoprotein-cholesterol (LDL-C), and higher systolic and diastolic blood pressure, but lower body mass index (BMI) and hemoglobin A1c (HbA1c). Compared to ALD, MetALD showed lower liver enzymes, while most metabolic parameters were similar. MetALD has distinct laboratory and metabolic features compared to MASLD, while differences with ALD are less pronounced. These findings favor MetALD as a distinct entity warranting further, more focused research.