Though both MASLD and ALD share a multifactorial pathogenesis, mainly driven by lipotoxicity from excessive accumulation of lipids and insulin resistance leading to systemic proinflammatory and oxidative stress [26–28], patients with ALD are particularly susceptible to PCM due to the combined physiological impacts of alcohol use and chronic liver inflammation [29]. Here, INS is linked to metabolic dysfunction-associated steatotic liver disease.