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Zerehpooshnesfchi et al. Metab Target Organ Damage. 2025;5:15 Metabolism and
DOI: 10.20517/mtod.2025.04
Target Organ Damage

Review Open Access

Dual etiology vs. MetALD: how MAFLD and MASLD
address liver diseases coexistence

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Shadi Zerehpooshnesfchi , Amedeo Lonardo , Jian-Gao Fan , Reda Elwakil , Tawesak Tanwandee , Munira
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Y. Altarrah , Necati Örmeci , Mohammed Eslam 1
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Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead 2145,
Australia.
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Department of Internal Medicine, Ospedale Civile di Baggiovara (-2023), Azienda Ospedaliero-Universitaria, Modena 41125,
Italy.
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Center for Fatty Liver, Department of Gastroenterology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of
Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai 200082, China.
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Tropical Medicine Department, Faculty of Medicine, Ain Shams Universit, Cairo 11517, Egypt.
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Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital(-2023), Mahidol University,
Bangkok 10700, Thailand.
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Gastroenterology and Transplant Hepatology Unit, Thunayan Al Ghanim Gastroenterology Center, Al Amiri Hospital, Kuwait
City 35001, Kuwait.
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Department of Gastroenterology, İstanbul Health and Technology University, İstanbul 34452, Türkiye.
Correspondence to: Prof. Mohammed Eslam, Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital
and University of Sydney, 176 Hawkesbury Road, Westmead 2145, Australia. E-mail: mohammed.eslam@sydney.edu.au
How to cite this article: Zerehpooshnesfchi S, Lonardo A, Fan JG, Elwakil R, Tanwandee T, Altarrah MY, Örmeci N, Eslam M.
Dual etiology vs. MetALD: how MAFLD and MASLD address liver diseases coexistence. Metab Target Organ Damage. 2025;5:15.
https://dx.doi.org/10.20517/mtod.2025.04
Received: 13 Jan 2025 First Decision: 28 Feb 2025 Revised: 7 Mar 2025 Accepted: 21 Mar 2025 Published: 27 Mar 2025
Academic Editor: Linda L. Henry Copy Editor: Ting-Ting Hu Production Editor: Ting-Ting Hu
Abstract
Fatty liver disease associated with metabolic dysfunction has emerged as a significant global health challenge. This
condition often coexists with other liver diseases, such as alcohol-related liver disease and viral hepatitis,
complicating both diagnosis and management. To address the limitations of the non-alcoholic fatty liver disease
(NAFLD) classification, two alternative frameworks have been proposed: metabolic dysfunction-associated fatty
liver disease (MAFLD) in 2020 and metabolic dysfunction-associated steatotic liver disease (MASLD) in 2023. A
key difference between these definitions is how they consider fatty liver disease in relation to the coexistence of
other liver conditions. MAFLD adopts a dual etiology concept, creating a unified classification system that aligns
with contemporary clinical and epidemiological needs. In contrast, MASLD introduces a new term, MetALD
(metabolic and alcohol-related/associated liver disease), to describe patients who have both metabolic

© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0
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