Comparison of non-alcoholic fatty liver disease (NAFLD) vs alcoholic liver disease
general features comparing non-alcoholic fatty liver disease (NAFLD) vs alcoholic liver disease
| NAFLD | alcoholic liver disease |
body weight | increased | variable |
fasting plasma glucose or HbA1c | increased | normal |
reported daily alcohol intake | <20 g for women, <30 g for men | >20 g for women, >30 g for men |
alanine aminotransferase (ALT) | increased or normal | increased or normal |
aspartate aminotransferasse (AST) | normal | increased |
AST:ALT ratio | <0.8 (>0.8 in advanced disease) | >1.5 |
γ glutamyltransferase (GGT) | increased or normal | considerably increased |
triglycerides | increased | variable, may be considerably increased |
HDL cholesterol | low | increased |
mean corpuscular volume | normal | increased |
In June 2023, a multi-society Delphi consensus statement on a new fatty liver disease nomenclature was published, introducing the term metabolic dysfunction-associated steatotic liver disease (MASLD) (2)
- MASLD has been estimated to affect 30% of the adult population worldwide, with its prevalence increasing from 22% to 37% from 1991 to 2019
- the increasing prevalence of MASLD parallels the increasing prevalence of obesity and obesity-related diseases
- metabolic dysfunction-associated steatohepatitis (MASH) is the more severe form of MASLD, is defined histologically by the presence of lobular inflammation and hepatocyte ballooning, and is associated with a greater risk of fibrosis progression
The classification system detailed different types of steatotic liver disease:
- Metabolic dysfunction-associated steatotic liver disease (MASLD):
- formerly known as NAFLD
- defined by ≥5% hepatic steatosis and the presence of at least 1 cardiometabolic risk factor (eg, dyslipidemia or obesity), with no other underlying causes and minimal or no alcohol intake (ie, <20 g/day for females and <30 g/day for males)
- Metabolic dysfunction-associated steatohepatitis (MASH):
- previously known as NASH
- Metabolic dysfunction and alcohol-associated liver disease (MetALD):
- refers to patients with hepatic steatosis, at least 1 metabolic risk factor, and moderate alcohol consumption, defined as 20 to 50 g/day for females and 30 to 60 g/day for males
- MetALD may result from a combination of metabolic dysfunction and moderate alcohol consumption, representing a spectrum between MASLD-predominant and alcohol-predominant disease
- Alcohol-associated liver disease (ALD):
- this is the subset of patients with steatosis and heavy alcohol use (>50 g/day for females, >60 g/day for males)
Reference:
- (1) Sattar N, Forrest E, Preiss D. Non-alcoholic fatty liver disease. BMJ. 2014;349:g4596
- (2) Chan WK, Chuah KH, Rajaram RB, Lim LL, Ratnasingam J, Vethakkan SR. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review. J Obes Metab Syndr. 2023 Sep 30;32(3):197-213.
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