Non-invasive tests for MetALD and alcohol-related liver disease

Abstract

Metabolic- and alcohol-related liver disease (MetALD) and alcohol-related liver disease (ALD) are major drivers of the global burden of cirrhosis. While metabolic dysfunction-associated steatotic liver disease (MASLD) affects nearly one-third of the global population, ALD and MetALD, though far less common, account for a disproportionately high rate of liver-related complications and deaths. Despite this, research and clinical focus on ALD and MetALD remain limited. A critical barrier is the late stage at which these conditions are typically diagnosed, often after the onset of decompensation. In this review, we explore the potential of non-invasive tests (NITs) to change the diagnostic landscape of ALD and MetALD. NITs offer a practical and scalable means to detect liver disease at earlier, compensated stages, before symptoms emerge, thereby opening a window for timely intervention. Beyond diagnosis, these tools also serve important roles in risk assessment, disease monitoring, and evaluating treatment response. As interest in therapeutic developments for ALD and MetALD grows, NITs are expected to become central to trial design, helping to identify suitable participants, assess ongoing alcohol use, and monitor efficacy without reliance on invasive biopsies. We also discuss broader strategies necessary to support early detection, including policy changes, stigma reduction, and improved access to care. Finally, we consider emerging biomarkers and their promise in advancing precision medicine approaches tailored to this high-risk patient population.