Objectives: Steatotic liver disease (SLD) comprises two major entities: alcohol-associated liver disease (ALD) and metabolic dysfunction-associated steatotic liver disease (MASLD). Despite the overlapping clinical features, these conditions differ substantially in terms of intrahepatic injury patterns and extrahepatic metabolic risk profiles. This study aimed to clinically differentiate ALD and MASLD using representative comparative cases.Methods: Two age-matched patients (both 63 years old)-a male with ALD and a female with MASLD-were evaluated. Intrahepatic features were assessed using transient elastography, including hepatic steatosis by controlled attenuation parameters (CAP) and fibrosis by liver stiffness measurements (LSM). Extrahepatic metabolic risk, comorbidities, and biochemical parameters were also compared.Results: The male patient with a history of heavy alcohol consumption showed minimal hepatic steatosis (CAP, 218 dB/m; S0) but significant liver fibrosis (LSM 8.6 kPa, F2). In contrast, the female patient met the diagnostic criteria for MASLD and presented with severe hepatic steatosis (CAP 333 dB/m, S3), hypertension, hyperlipidemia, and borderline diabetes mellitus, while liver fibrosis remained within the normal range (LSM 5.1 kPa, F0-F1). Both patients exhibited biochemical evidence of hepatic inflammation, with elevated alanine aminotransferase (ALT: 44 and 52 IU/L) and γ-glutamyltransferase (GGT: 118 and 69 IU/L) levels.Conclusion: These contrasting cases highlight the distinct clinical phenotypes of ALD and MASLD, characterized by an intrahepatic injury-dominant risk in ALD and extrahepatic metabolic risk-dominant features in MASLD. This comparative case report provides clinically relevant insights into individualized management strategies for SLD, particularly in Korean medicine-based clinical practice.
Chang-Gue Son (Mon,) studied this question.