Steatotic liver disease (SLD) is fast becoming one of the most prevalent and pressing global health challenges. Driven by rising rates of obesity, insulin resistance, metabolic dysfunction, and alcohol use, SLD is characterised by the build-up of fat in the liver. Left unchecked, this can trigger inflammation, fibrosis, cirrhosis, and even hepatocellular carcinoma.

SLD affects people across the life course, from adults with metabolic syndrome to a growing population of children and adolescents, where paediatric MASLD is emerging as a major concern. This rise parallels the obesity epidemic and reflects the complex interplay between environment, lifestyle, and genetics.

A 2023 international Delphi consensus has ushered in a major shift in how we define and diagnose SLD. The updated nomenclature, designed to be more inclusive, clinically relevant, and aligned with pathophysiological mechanisms, distinguishes between:

• MASLD (Metabolic dysfunction-associated SLD)
• ALD (Alcohol-related liver disease)
• MetALD (a dual aetiology combining metabolic dysfunction and alcohol use)

This redefinition not only captures the reality of overlapping risk factors but also highlights the dangers of even moderate alcohol consumption in individuals with underlying metabolic dysfunction.

Our department is at the forefront of this transformation. With one of the largest paediatric and adult SLD and bariatric clinical services in the UK, we are uniquely positioned to lead translational and experimental medicine programmes. Our research integrates:

• Basic science and organ pathophysiology
• Experimental therapies and biomarker discovery
• Clinical trials and real-world cohort studies

We work closely with diabetes and endocrinology teams to address the systemic nature of metabolic liver disease and ensure joined-up care across disciplines.

From bench to bedside, we are committed to reducing the burden of SLD and improving outcomes for all patients, at every stage of life.