In November 2024， the Expert Group on Alcohol-related Liver Disease released a position statement on metabolic dysfunction and alcohol-related liver disease （MetALD）. MetALD is a new subtype of steatotic liver disease and refers to MASLD patients with a relatively large amount of alcohol consumption. The position statement points out the importance of accurate evaluation of alcohol consumption and recommends to quantify alcohol consumption using standard methods and alcohol biomarkers， and a comprehensive diagnosis should be made based on metabolic risk factors. In addition， the position statement analyzes the influence of drinking pattern on the diagnosis of MetALD and recommends to consider long-term drinking history during typing. The position statement also discusses the complex association between drinking and the diseases including metabolic syndrome， hepatic steatosis， fibrosis， and type 2 diabetes mellitus， and it is pointed out that the hierarchical management of patients should be optimized based on liver histological models and noninvasive models. The position statement elaborates on the definition of MetALD， drinking assessment， the interaction between alcohol use and metabolic dysfunction， and the methods for comprehensive management of MetALD， in order to facilitate learning and provide guidance for clinicians and researchers in clinical practice.

Metabolic associated fatty liver disease (MAFLD) is closely related to obesity, insulin resistance and metabolic syndrome and has become the main cause of chronic liver disease worldwide. Lifestyle intervention is the first-line treatment for MAFLD, and with the deepening of research on its pathogenesis, there have been breakthrough advancements in pharmacological therapies. Resmetirom, a thyroid hormone receptor β agonist, has become the first approved drug for the treatment of metabolic associated steatohepatitis (MASH). Additionally, fibroblast growth factor-21 analogs, incretin receptor agonists and sodium-glucose cotransporter 2 inhibitors have also achieved positive results. However, MAFLD/MASH treatment still faces many challenges: uncertain long-term drug efficacy and low histological response rate, lack of efficacy data for special populations such as children and the elderly, and limited evidence of metabolic outcome benefits. Therefore, future research needs to focus on multidisciplinary treatment, precision medicine, and combined therapies targeting liver and metabolic aspects to promote the development of personalized treatment for MAFLD/MASH.

Metabolic associated fatty liver disease (MAFLD) is closely related to obesity, insulin resistance and metabolic syndrome and has become the main cause of chronic liver disease worldwide. Lifestyle intervention is the first-line treatment for MAFLD, and with the deepening of research on its pathogenesis, there have been breakthrough advancements in pharmacological therapies. Resmetirom, a thyroid hormone receptor β agonist, has become the first approved drug for the treatment of metabolic associated steatohepatitis (MASH). Additionally, fibroblast growth factor-21 analogs, incretin receptor agonists and sodium-glucose cotransporter 2 inhibitors have also achieved positive results. However, MAFLD/MASH treatment still faces many challenges: uncertain long-term drug efficacy and low histological response rate, lack of efficacy data for special populations such as children and the elderly, and limited evidence of metabolic outcome benefits. Therefore, future research needs to focus on multidisciplinary treatment, precision medicine, and combined therapies targeting liver and metabolic aspects to promote the development of personalized treatment for MAFLD/MASH.