356 Ch 355. Alcoholic Liver Disease (ALD) and Metabolic-Associated Steatotic Liver Disease (MASLD)

2023-2024 AASLD/EASL/ALEH nomenclature change：NAFLD → MASLD (Metabolic dysfunction-Associated Steatotic Liver Disease) + NASH → MASH；Alcohol-related liver disease (ALD) + MASLD = leading causes of liver disease globally；台灣 MASLD 盛行率 25-30% adults (rising with obesity)；ALD spectrum：(1) alcoholic fatty liver (steatosis) — reversible；(2) alcoholic hepatitis (AH) — acute, AST > 2x ALT classical, Maddrey > 32 = severe；(3) alcoholic cirrhosis；MASLD spectrum：(1) steatosis (MAFL — metabolic-associated fatty liver)；(2) MASH (metabolic-associated steatohepatitis) — fibrosis risk；(3) cirrhosis + HCC；metabolic risk factors：obesity + DM + dyslipidemia + HTN + metabolic syndrome；diagnosis：imaging (US, CT, MRI) + non-invasive fibrosis (FIB-4, NFS, FibroScan, ELF, MR elastography) + biopsy (uncertain cases)；treatment：(1) weight loss (≥ 5-10%) cornerstone；(2) GLP-1 RA (semaglutide), GIP/GLP-1 (tirzepatide) for obesity + MASLD/MASH；(3) resmetirom (Rezdiffra, FDA 2024) — first FDA-approved MASH drug；(4) bariatric surgery for severe obesity；ALD：alcohol cessation foundational + corticosteroids for severe AH (Lille score guides) + liver transplant in select。