Background and AimsThe new nomenclature of steatotic liver disease (SLD) was recently launched with sub-classifications of metabolic dysfunction-associated SLD (MASLD), MASLD with increased alcohol intake (MetALD), and Alcohol-related liver disease (ALD). We aim to evaluate the characteristics, long-term outcomes of these subgroups and the utility of noninvasive biomarkers. MethodsUsing the National Health and Nutrition Examination Survey (NHANES) III and their linked mortality data, all adult participants with available ultrasonographic liver steatosis status were included. Those with viral hepatitis, incomplete data on alcohol consumption, cardiometabolic risk, and for SAFE score calculation were excluded. The characteristics of those without SLD (no steatosis on ultrasound), MASLD, MetALD, and ALD were compared. The overall survivals (OS) were determined and SAFE score strata were applied to SLD subgroups. ResultsA total of 9,939 participants were eligible, 64% had no SLD, while 30%, 2.3%, and 1% had MASLD, MetALD, and ALD, respectively. A higher proportion of men was observed in MetALD and ALD than in MASLD as well as active smoker. Diabetes was more prevalent in MASLD than in MetALD and ALD. ALD subgroup demonstrated significantly lower OS than MASLD (p=0.004), but the MetALD did not (p=0.165). SAFE score strata meaningfully differentiated OS of all SLD subgroups. ConclusionsThe largest proportion of SLD was MASLD. MetALD shared the characteristics of both MASLD and ALD. ALD subgroup had a significantly lower OS than MASLD but no difference between MetALD and MASLD. SAFE score can be used to stratify long-term outcomes in all SLD subgroups. Impact and implications“Steatotic Liver Disease (SLD)” is a recently introduced term covering 3 subgroups 1) metabolic dysfunction-associated SLD (MASLD), 2) MASLD and increased alcohol intake (MetALD), and 3) Alcohol-related liver disease (ALD). We explored the characteristics and outcomes of these subgroups among US population. We found that MASLD was far more common than MetALD and ALD but all subgroups shared cardiometabolic risk factors. ALD subgroup has the worst survival, pointing out the synergistic effect of alcohol and metabolic dysfunction. In addition, SAFE score might be a useful noninvasive test to stratify long-term risk in all 3 SLD subgroups.