SIG Greatest Hits: TLM 2025-MASLD SIG: Natural History and Disease Progression of MetALD

Video Transcription

Video Summary

Dr. Juan Pablo Arab discussed the natural history and progression of MET-ALD, emphasizing its underestimated prevalence (~4% of the population, 10% among SLD patients) and dual injury from metabolic factors and alcohol. He highlighted complex interactions where alcohol contributes to cardiometabolic risks like hypertension, dyslipidemia, diabetes, and obesity, compounding liver damage. Disease progression in ALD is faster and more severe compared to MASLD, with MET-ALD falling between them. Even moderate drinking accelerates liver disease in MET-ALD. Cardiovascular outcomes are significant and must be considered alongside liver complications. MET-ALD is increasingly a cause for liver transplantation, with worse post-transplant outcomes than ALD alone. Biomarkers such as PEV improve assessment beyond self-reporting, and genetic factors (e.g., PNPLA3 variant) greatly increase cirrhosis risk. A holistic approach addressing alcohol use disorder, cardiometabolic risks, and liver disease is essential for effective management and precision medicine in MET-ALD patients.

Asset Subtitle

Talk delivered by Dr. Juan Pablo Arab. Talk was part of the Steatotic Liver Disease: What You Need to Know, Part 1. Steatotic Liver Disease at the Crossroads—Bridging Alcohol-Associated Liver Disease and Metabolic Dysfunction-Associated Steatotic Liver Disease in the Era of Multimorbidity session.

Keywords

MET-ALD

alcohol-related liver disease

cardiometabolic risks

liver transplantation

PNPLA3 genetic variant