The nomenclature of steatotic liver disease advanced our understanding of the interplay between alcohol and cardiometabolic risk factors. The new nomenclature introduced a new entity of metabolic dysfunction and alcohol-associated liver disease or metabolic dysfunction-associated alcohol-related liver disease (MetALD). This brought in challenges like granular self-reported quantification on self-reported alcohol use and changing disease states due to dynamic alcohol use, with risk of misclassification of alcohol use. Given a worldwide increasing prevalence of metabolic syndrome and of alcohol use, this article delves into a global perspective on the challenges and opportunities in the understanding of MetALD.