Clinical management & treatment strategies for MetALD in Japan

The prevalence of MetALD is approximately 20% of patients with SLD in Japan. It remains unclear if MetALD has more impact on the various events than MASLD. However, a recent large-scale Japanese cohort study by JSG-NAFLD demonstrated that the prevalence of advanced fibrosis was higher in male patients with MetALD compared to those with MASLD. A nationwide, population-based study by Tamaki et al. further demonstrated that the cumulative incidence of liver-related events was higher in patients with MetALD than MASLD. In contrast, the incidence of major adverse cardiovascular events was lower in patients with MetALD than MASLD. A nationwide, population-based study by Kimura et al. also demonstrated that the cumulative incidence of colorectal cancer was higher in patients with MetALD than MASLD. Moreover, we investigated the impact of MetALD on the incidence of reflux esophagitis. We found that the cumulative incidence of reflux esophagitis was higher in patients with MetALD than MASLD. Thus, the cumulative incidence of liver-related events, colon cancer, and reflux esophagitis is higher in patients with MetALD than in patients with MASLD. Taken together, moderate alcohol consumption and MASLD synergistically increase the incidence of various events. Therefore, both abstinence/moderation in alcohol consumption and dietary/exercise therapy are deemed important for patients with MetALD. Additionally, pharmacotherapy for concomitant metabolic abnormalities should also be utilized.