Liver and atherosclerotic risk of alcohol consumption in patients with metabolic dysfunction-associated Steatotic Liver Disease

Background/purpose: A new disease name, "Steatotic Liver Disease (SLD)" was proposed in 2023. Within this algorithm, combined metabolic and alcoholic liver disease (MetALD) was named as a new specific subgroup. The clinical profiles and outcomes of MetALD patients are unknown. Methods: Participants from Taiwan Biobank database after exclusion those with positive for HBsAg, anti-HCV, and former drinkers were selected. MASLD was diagnosed if having hepatic steatosis on ultrasound plus at least one of cardiometabolic criteria. Increased or moderate alcohol intake was defined as continuous drinkers with alcohol consumption exceeding 210 g for men and 140 g for women weekly or below the levels, respectively. The fibrosis 4 (FIB-4) score was used to assess the severity 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 7316 (40.3 %) MASLD patients and 209 (1.2 %) MetALD patients. The participants with MetALD 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: MetALD patients have a higher risk of liver injury than those with MASLD. Moreover, moderatet alcohol intake also increases the risk of liver injury and atherosclerotic in MASLD patients, suggesting MASLD patients should refrain from alcohol intake.