We have carefully reviewed the recent study by Park et al., which examines the relationship between metabolic dysfunction-associated steatotic liver disease (MASLD), its alcohol-associated subtype (MetALD) and cancer risk [1]. The study provides valuable data, highlighting the increased risk of liver and gastrointestinal cancers in patients with MASLD and MetALD. While this is a noteworthy contribution, we believe that several key issues warrant further exploration to enhance the clinical applicability of this new disease classification.

First, although the new nomenclature offers a more detailed classification of MASLD and MetALD, it remains unclear whether this distinction will significantly improve patient management in clinical practice. The study mentions the association between alcohol consumption and cancer risk, but the definition of alcohol intake (e.g., moderate consumption of 30–60 g per day) may be interpreted and followed differently by individual patients, especially those with pre-existing metabolic dysfunction. Future research should consider developing more precise tools to evaluate the specific impact of alcohol consumption on cancer risk and provide clearer guidance for clinicians when managing MASLD and MetALD patients [2].

Second, we suggest that future studies focus on optimising intervention strategies. While the study demonstrates a clear link between MASLD, MetALD and increased cancer risk, it does not provide specific recommendations for interventions targeting this high-risk population. Some research has shown that a multidisciplinary approach integrating metabolic control and alcohol management can be an effective strategy for reducing cancer risk in such patients [3]. Prospective intervention studies will be essential in shaping preventive strategies.

Third, we question the global applicability of this new classification. Although the study is based on a national cohort in South Korea, the generalisability of MASLD and MetALD classifications on a global scale remains uncertain, given the diverse metabolic profiles, lifestyle habits and alcohol consumption patterns across different regions. Significant differences in cancer risk between Western and Asian populations highlight the need for cross-national cohort studies to verify the universality of these classifications across diverse populations [4, 5].

Lastly, although the study accounts for multiple known confounders (e.g., age, sex, BMI, diabetes and blood pressure), the role of unmeasured confounders cannot be entirely ruled out. Genetic factors, in particular, play a significant role in the development of MASLD and MetALD. Recent studies have shown that genetic variants such as PNPLA3 substantially increase the risk of alcohol-related and metabolic liver diseases [3]. While Park et al. emphasise metabolic and lifestyle factors, the interplay between genetic and metabolic pathways may further exacerbate cancer risk. We recommend that future research incorporates genetic factors to provide a more comprehensive assessment of the carcinogenic mechanisms underlying MASLD and MetALD.

In conclusion, while Park et al.'s study lays an important foundation for understanding the cancer risks associated with MASLD and MetALD, further research is needed to clarify its clinical implications and global relevance. Addressing these issues in depth will help refine prevention and intervention strategies to reduce the cancer burden associated with these newly defined conditions.

我们仔细回顾了 Park 等人最近的研究，该研究考察了代谢功能障碍相关脂肪性肝病 （MASLD）、其酒精相关亚型 （MetALD） 与癌症风险之间的关系 [1]。该研究提供了有价值的数据，突出了 MASLD 和 MetALD 患者患肝癌和胃肠道癌的风险增加。虽然这是一个值得注意的贡献，但我们认为几个关键问题值得进一步探索，以提高这种新疾病分类的临床适用性。

首先，尽管新命名法提供了 MASLD 和 MetALD 的更详细分类，但目前尚不清楚这种区分是否会显著改善临床实践中的患者管理。该研究提到了饮酒与癌症风险之间的关联，但酒精摄入量的定义（例如，每天适度饮酒 30-60 克）可能会因个体患者（尤其是那些预先存在代谢功能障碍的患者）而有不同的解释和遵循。未来的研究应考虑开发更精确的工具来评估饮酒对癌症风险的具体影响，并为临床医生在管理 MASLD 和 MetALD 患者时提供更明确的指导 [2]。

其次，我们建议未来的研究侧重于优化干预策略。虽然该研究表明 MASLD、MetALD 与癌症风险增加之间存在明确联系，但它并未为针对这一高危人群的干预措施提供具体建议。一些研究表明，整合代谢控制和酒精管理的多学科方法可以成为降低此类患者癌症风险的有效策略 [3]。前瞻性干预研究对于制定预防策略至关重要。

第三，我们质疑这种新分类的全球适用性。尽管该研究基于韩国的全国队列，但鉴于不同地区的代谢特征、生活习惯和饮酒模式不同，MASLD 和 MetALD 分类在全球范围内的普遍性仍不确定。西方和亚洲人群之间癌症风险的显著差异凸显了跨国队列研究的必要性，以验证这些分类在不同人群中的普遍性 [4， 5]。

最后，尽管该研究考虑了多个已知的混杂因素（例如，年龄、性别、BMI、糖尿病和血压），但不能完全排除未测量的混杂因素的作用。特别是遗传因素在 MASLD 和 MetALD 的发展中起着重要作用。最近的研究表明，PNPLA3 等遗传变异会显著增加酒精相关和代谢性肝病的风险 [3]。虽然 Park 等人强调代谢和生活方式因素，但遗传和代谢途径之间的相互作用可能会进一步加剧癌症风险。我们建议未来的研究结合遗传因素，以更全面地评估 MASLD 和 MetALD 的致癌机制。

总之，虽然 Park 等人的研究为理解与 MASLD 和 MetALD 相关的癌症风险奠定了重要基础，但需要进一步的研究来阐明其临床意义和全球相关性。深入解决这些问题将有助于改进预防和干预策略，以减轻与这些新定义的疾病相关的癌症负担。