and other diseases more frequently than currently recognized. A recent study of individuals with and without MASL/MASH confirms and extends these findings. Fasting BAC measured in the portal veins of individuals with MASL/MASH were significantly higher than in individuals without MASLD/MASH (medians; control 2.1 mM; MASLD 8.0 mM and MASH 21.0mM) (63). Additionally, the study shows that BAC, which was negligible at fasting, increased to measurable levels 2 hours after a meal tolerance test. Notably, individuals with more advanced liver disease exhibited the highest endogenous BAC, and BAC could be manipulated to increase or decrease by pre-treating patients with an infusion of an inhibitor of hepatic alcohol metabolism (4-methylpyrazole) or with a course of broad-spectrum antibiotics, respectively (63). These findings support a causal role of endogenous alcohol of microbial origin in liver disease and underscore the need for further research into this intriguing condition.
