MetALD is a new category of steatotic liver disease, or SLD (formerly known as fatty liver disease) that describes people who meet the criteria for metabolic dysfunction-associated steatotic liver disease, or MASLD, (formerly known as nonalcoholic fatty liver disease) but also consume significant amounts of alcohol regularly.
A person with MetALD:
- Has an excess of fat in the liver – more than 5 to 10 percent
- Consumes more than 140 g of alcohol per week if female (10+ drinks a week)
- Consumes more than 210 g of alcohol per week if male (15+ drinks a week)
- Has at least one of five cardiometabolic risk factors – obesity, high blood pressure, high cholesterol, high triglyceride, or high blood glucose levels (diabetes/prediabetes)
MetALD is a spectrum. Some cases of MetALD might act very similar to MASLD, while other cases may share more in common with alcohol-associated liver disease, or ALD.
Some people with MetALD go on to develop metabolic disfunction-associated steatohepatitis, or MASH, (formerly known as nonalcoholic steatohepatitis, or NASH), which damages the liver. MetALD also increases a person’s risk of developing heart disease, liver cancer, and cirrhosis (permanent scarring of the liver) in the future.
Symptoms
MetALD is most often a “silent” disease, meaning it typically has no noticeable symptoms. In some cases, a person may notice upper abdominal tenderness on the right side, fatigue, weakness, and weight loss.
Risk Factors
Although the causes of MetALD are unclear, certain conditions raise a person’s risk of developing the condition. Heavy alcohol use over time contributes to MetALD, although not everyone who drinks heavily will develop MetALD. Another common contributing factor is metabolic syndrome, a term that refers to a combination of conditions: obesity, diabetes, elevated cholesterol, and high blood pressure.
Risk factors for MetALD include
- Heavy alcohol use
- Obesity, especially if fat is concentrated in the belly (abdomen)
- Metabolic syndrome
- High cholesterol
- High triglyceride levels in the blood
- Type 2 diabetes or prediabetes
- High blood pressure
- Polycystic ovary syndrome
- Sleep apnea
- Underactive thyroid
- Underactive pituitary gland
When to See a Doctor
If you have risk factors for MetALD, it’s smart to see a doctor for a thorough exam and consultation. Early detection, diagnosis, and treatment can prevent MetALD from progressing to MASH.
If you want to control your drinking but are having trouble cutting back on alcohol, you are not alone. Your doctor can help connect you with support, resources, and treatments that can help you.
Treatment Options
For people with MetALD who have no symptoms, treatment may not be needed, although a doctor may recommend lifestyle changes – including reducing alcohol intake – to prevent further fatty buildup. Recommended lifestyle changes may include:
- Reducing alcohol intake
- Losing extra weight
- Eating a healthy diet
- Getting regular exercise
- Controlling diabetes (with medication, if needed)
- Reducing cholesterol and triglyceride levels in the blood (with medication, if needed)
- Talking with your doctor about other medications you’re taking that may affect your liver
If you’re trying to reduce your alcohol intake, your doctor can connect you with resources and treatments to help. Talk with your doctor about the options available to you.
Diagnostic Testing
The foremost diagnostic test for any condition is a thorough exam and consultation with a physician, including a review of your individual and family history. In addition, your physician may recommend any of the following tests or procedures, which may provide further diagnostic value:
- Liver Biopsy
- Liver Imagining
- Blood Test
Prevention
Many of MetALD’s causes are treatable or preventable, so talk with your doctor about your risk factors. In addition, it is important to avoid alcohol, or to drink alcohol only in moderation. If you develop MetALD, it may be possible to prevent your condition from getting worse with lifestyle changes.
Learn More
Learn more about MetALD with resources from the National Institutes of Health.