Metabolic dysfunction-associated steatotic liver disease: Current perspectives

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), represents the most prevalent chronic liver condition worldwide. Affecting approximately one-third of the global population, MASLD is strongly associated with obesity, insulin resistance, type 2 diabetes mellitus (T2DM), dyslipidemia, and metabolic syndrome. The renaming to MASLD underscores the central role of metabolic dysfunction in its pathogenesis and clinical spectrum. The disease ranges from simple hepatic steatosis to metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Non-invasive biomarkers and imaging modalities have improved risk stratification, but liver biopsy remains the gold standard for diagnosis and staging. Current management strategies emphasize lifestyle interventions, weight loss, and cardiometabolic risk control, with emerging pharmacotherapies showing promise. MASLD poses a major burden on healthcare systems due to its progressive nature and extrahepatic associations with cardiovascular disease, chronic kidney disease, and malignancies. This review provides an updated overview of epidemiology, pathogenesis, diagnosis, management, and future directions in MASLD, highlighting evolving therapeutic opportunities and research priorities.