Alcoholic liver disease (ALD) remains a major cause of chronic liver diseases 
and liver failure. Population-based prospective studies and patient cohort 
studies have demonstrated that obesity and the metabolic syndrome exacerbate 
progression of ALD and increase hepatocellular carcinoma (HCC) incidence and 
mortality. Emerging evidence also suggests a synergism between alcohol and 
obesity in mortality and HCC incidence. Recognition of these increased risks and 
detection of early-stage liver disease may offer the opportunity to address 
these modifiable risk factors and prevent disease progression in these patients.