After adjusting for underestimation of alcohol consumption, the prevalence of alcohol-related liver disease in the US was found to be higher than previously reported[1][4]. The strongest risk factor is excessive drinking[1][2]. In the USA, alcoholic steatosis has a prevalence of 4.3% of the population[1][4]. The prevalence of advanced fibrosis increased from 2.2% in 2001–2002 to 6.6% in 2015–2016[1]. Americans who drink heavily have more than double the risk of significant liver damage compared to 20 years ago[2]. A study by Keck Medicine of USC analyzed data from the 1999–2020 NHANES and identified four risk groups: women, adults over 45, people in poverty, and people with metabolic syndrome[2]. The overall prevalence of ALD in the US remains stable at around 0.8–1% from 1988 to 2016[1].