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Nasr et al. Metab Target Organ Damage 2023;3:19 https://dx.doi.org/10.20517/mtod.2023.20 Page 3 of 17

Table 1. Factors, other than metabolic dysfunction-associated steatotic liver disease, that have been associated with hepatic lipid
accumulation
Nutritional Drugs and toxins Inborn errors of metabolism Other conditions
GI surgery for obesity 5-Fluorouracil Abetalipoproteinemia AFLP
Malnutrition Acetylsalicylic acid, Galactosemia Environmental toxins
Rapid weight loss Alcohol Glycogen storage disease -Toxic mushrooms
Starvation Amiodarone Hereditary fructose intolerance -Phosphorus
TPN Carbamazepine Homocysteinuria -Petrochemicals
Cocaine LAL-D/CESD/WD -Organic solvents
Diclorethylene LCAT deficiency HELLP syndrome
Didanosine (NRTI) Systemic carnitine deficiency Hepatitis C
DH Tyrosinemia HIV
Diltiazem Weber-Christian syndrome IBD
Estrogen Wilson’s disease Lipodystrophia
Ethionine Reye’s syndrome
Ethyl bromide Severe anemia
Glucocorticoids SIBO
Hydrazine Endocrine disorders
Hypoglycin -Hypothyroidism
Interferon -HPD
Irinotecan -Cushing’s disease
Margosa oil -PCOS
Methotrexate -Type 2 diabetes
NSAID Cessation of PA
Perhexeline maleate
Protease inhibitors
Safrole
Stavudine (NRTI)
Tamoxifen
Tetracycline
Valproic acid
Vitamin A
Zidovudine (NRTI)
AFLP: acute fatty liver of pregnancy; CESD: cholesterol ester storage disease; DH: diethylaminoethoxyhexestrol; GI: gastrointestinal; HELLP:
hemolysis, elevated liver enzymes, low platelet count; HIV: human immunodeficiency virus; HPD: hypothalamic-pituitary disorders; IBD:
inflammatory bowel syndrome; LAL-D: lysosomal acid lipase deficiency; LCAT: lecithin-cholesterol acetyltransferase; NRTI: nucleoside reverse
transcriptase inhibitors; NSAID: nonsteroidal anti-inflammatory drug; PA: physical activity; PCOS: polycystic ovary syndrome; SIBO: small
intestinal bacterial overgrowth; TPN: total parenteral nutrition; WD: Wolman’s disease.

and if consumption exceeds these thresholds but is below 420 g/week for men and 350 g/week for women,
the diagnosis of MetALD is used. However, if alcohol consumption exceeds the thresholds for MetALD, the
diagnosis of ALD is recommended .
[8]

Since differentiating between MASLD, MetALD, and ALD, histopathologically, is difficult, one must rely on
patient history, standardized questionnaires, or biomarkers for the correct diagnosis. When diagnosing
MASLD, the proposed tool for excluding excessive alcohol consumption is the AUDIT (i.e., Alcohol Use
Disorder Inventory Test), which has an adequate test-retest agreement (kappa (κ) agreement of 0.7) [30,31] .
The AUDIT consists of ten questions exploring consumption (Q1-3), dependence (Q4-6), and alcohol-
[32]
related problems (Q7-10) . Abbreviated forms have been developed, where the one most regularly used is
the AUDIT-C (i.e., AUDIT-Consumption) questionnaire, which includes Q1-3 of the AUDIT .
[33]