In the absence of alcohol consumption, obese mice and obese patients with MASLD have significantly higher blood and exhaled ethanol concentrations than do controls,94, 95which further rise with MASLD worsening and are reversible by antibiotic treatment.96, 97Burger et al98recently found reduced ADH activity in the blood and livers of mice and patients with MASLD, potentially linking to TNF-α–c-Jun N-terminal kinase (JNK) pathway activation and subsequent ADH serine hyperphosphorylation. Here, AVP is linked to metabolic dysfunction-associated steatotic liver disease.