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Nasr et al. Metab Target Organ Damage 2023;3:19 Metabolism and
DOI: 10.20517/mtod.2023.20
Target Organ Damage

Review Open Access

Non-metabolic causes of steatotic liver disease

1
Patrik Nasr 1,2 , Cecilia Jönsson , Mattias Ekstedt 1 , Stergios Kechagias 1
1
Department of Gastroenterology and Hepatology, Department of Health, Medicine and Caring Sciences, Linköping University,
Linköping SE-581 85, Sweden.
2
Wallenberg Centre for Molecular Medicine, Linköping University, Linköping SE-581 85, Sweden.
Correspondence to: Dr. Patrik Nasr, Department of Gastroenterology and Hepatology, University Hospital, SE-581 85 Linköping,
Sweden. E-mail: Patrik.nasr@liu.se

How to cite this article: Nasr P, Jönsson C, Ekstedt M, Kechagias S. Non-metabolic causes of steatotic liver disease. Metab Target
Organ Damage 2023;3:19. https://dx.doi.org/10.20517/mtod.2023.20
Received: 15 Jun 2023 First Decision: 28 Sep 2023 Revised: 10 Oct 2023 Accepted: 12 Oct 2023 Published: 26 Oct 2023

Academic Editor: Stefano Ballestri Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Hepatic steatosis is caused by exaggerated hepatic lipid accumulation and is a common histological and
radiological finding. Non-alcoholic fatty liver disease (NAFLD), or metabolic dysfunction associated steatotic liver
disease (MASLD), is highly associated with metabolic syndrome and represents the most common cause of
hepatic steatosis. However, since several comorbidities, lifestyle factors, and drugs can cause hepatic steatosis,
MASLD is, to some extent, a diagnosis of exclusion. Nevertheless, initiatives have been taken to encompass
positive (instead of negative) criteria for diagnosis - such as the presence of cardiometabolic risk factors together
with hepatic steatosis. Nonetheless, before confirming a patient with MASLD, it is essential to map and evaluate
other causes of fatty liver disease or steatotic liver disease. Several causes of hepatic steatosis have been identified
in studies; however, the study cohorts are scarce and often anecdotal. Additionally, many studies have shown
correlation without proving causation, and many are retrospective without reporting relevant patient
characteristics and comorbidities - making it difficult to draw conclusions regarding the underlying etiology or
present comorbidity of hepatic steatosis. In this narrative review, we aimed to identify and summarize present
studies evaluating the impact of the most common and often suggested causes of hepatic steatosis.

Keywords: Hepatic steatosis, SLD, alcohol-related liver disease, alcohol-associated liver disease, ALD,
methotrexate, tamoxifen, non-alcoholic fatty liver disease, NAFLD, metabolic-dysfunction associated liver disease,
MASLD, MetALD, fatty liver disease
INTRODUCTION
Steatotic liver disease (SLD) is caused by hepatic lipid accumulation and is a common finding encountered

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
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