Reau highlights data examining patient reluctance to disclose alcohol consumption, using phosphatidylethanol (PEth) testing as an objective biomarker. The conversation then turns to how PEth testing can be integrated into practice. She also notes the implications for clinical trials, pointing out that many study populations likely include patients with overlapping metabolic disease and alcohol use, given the limitations of self-reporting. This risk was compounded by the presence of multiple metabolic factors, with alcohol acting as another “layer” of risk that accelerates disease progression. Reau and Brown agree that for patients with MASLD, particularly younger individuals with decades of disease risk ahead, no amount of alcohol is truly safe, and addressing this openly is essential to long-term outcomes.