Coexistence of metabolic dysfunction-associated steatotic liver disease and chronic hepatitis B (HBV) or C virus (HCV) infection is not uncommon. Hepatic steatosis without metabolic dysfunctions may have favorable effect...Coexistence of metabolic dysfunction-associated steatotic liver disease and chronic hepatitis B (HBV) or C virus (HCV) infection is not uncommon. Hepatic steatosis without metabolic dysfunctions may have favorable effects on HBV increasing HBV surface antigen loss and preventing fibrosis progression, while steatohepatitis with metabolic dysfunctions increases the risk of fibrosis progression and hepatocellular carcinoma. In HCV genotype 3, hepatic steatosis is virus-induced and improves/resolves after viral clearance, while it is metabolic driven in other HCV genotypes persisting after viral clearance and contributing to ongoing liver injury. Treatment of metabolic parameters is mandatory for optimal management of patients with HCV.
Metabolic dysfunction-associated steatotic liver disease and its progressive form, metabolic dysfunction-associated steatohepatitis, are expanding across Australia, Central America, and the Caribbean, driven by obesity,...Metabolic dysfunction-associated steatotic liver disease and its progressive form, metabolic dysfunction-associated steatohepatitis, are expanding across Australia, Central America, and the Caribbean, driven by obesity, diabetes, and social disadvantage. The authors synthesize contemporary epidemiology, highlighting rising prevalence, projected surges in advanced disease and mortality, and heterogeneity by most relevant sociodemographic characteristics. They outline pragmatic, resource-adaptable care pathways that begin with Fibrosis-4 in primary care and escalate to elastography or direct fibrosis biomarkers, noting access bottlenecks outside metropolitan hubs and smaller islands. They summarize models of care-multidisciplinary and nurse-led clinics and mobile and community-health worker programs-and emphasize lifestyle modification.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major public health concern in Latin America, where prevalence exceeds 40%. A high frequency of genetic risk variants, particularly the PNPLA3 risk al...Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major public health concern in Latin America, where prevalence exceeds 40%. A high frequency of genetic risk variants, particularly the PNPLA3 risk allele, contributes to greater disease prevalence and severity across the region. Fragmented health systems, shortages of trained personnel, and limited access to advanced noninvasive diagnostic tools and emerging pharmacotherapies constrain MASLD effective care in the region. These structural barriers highlight the need for coordinated public health strategies to expand screening, strengthen diagnostic capacity, and improve equitable access to treatment. This review summarizes regional epidemiology, diagnostic gaps, and health system priorities for addressing MASLD in Latin America.
Metabolic dysfunction-associated steatotic liver disease and steatohepatitis are rising across Africa, driven by obesity, diabetes, urbanization, and social determinants, with regional heterogeneity. North Africa shows t...Metabolic dysfunction-associated steatotic liver disease and steatohepatitis are rising across Africa, driven by obesity, diabetes, urbanization, and social determinants, with regional heterogeneity. North Africa shows the highest prevalence, while several sub-Saharan regions have the fastest growth. Coexisting hepatitis B virus, hepatitis C virus, and HIV accelerate fibrosis and complicate hepatocellular carcinoma surveillance. A scalable response is resource stratified triage from non-hepatology settings using FIB-4 with age-adjusted cutoffs, selective elastography, and clear referral thresholds, integrated into noncommunicable disease programs; management prioritizes weight loss, cardiometabolic control, and access to effective therapies.
Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis, represent rapidly growing health challenges in Asia. This review summarizes the...Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis, represent rapidly growing health challenges in Asia. This review summarizes the epidemiology, genetic predispositions, clinical features, diagnostic approaches, and treatment strategies for MASLD across diverse Asian populations. Distinctive aspects include high prevalence of lean and nonobese MASLD, strong influence of risk variants, such as PNPLA3, and unique mortality patterns compared with Western cohorts. Diagnostic practices must consider region-specific body mass index thresholds, limited access to noninvasive tests, including elastography, and coexisting viral hepatitis. Greater inclusion of Asian patients in clinical trials is essential for tailored management strategies.
Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive subtype, metabolic dysfunction-associated steatohepatitis (MASH), are growing global health concerns. In the Middle East, rising rates...Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive subtype, metabolic dysfunction-associated steatohepatitis (MASH), are growing global health concerns. In the Middle East, rising rates of obesity and diabetes contribute to an increasing burden of MASLD and MASH. However, countries across the region vary in care models, health care infrastructure, and workforce capacity. Gaps remain in health policy, research infrastructure, and participation in global studies. This review outlines the current landscape of MASH in the Middle East and discusses strategies to strengthen diagnosis, management, and regionally relevant evidence generation.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most common chronic liver disease in children, with rising prevalence and substantial systemic consequences. This review synthesizes recent adva...Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most common chronic liver disease in children, with rising prevalence and substantial systemic consequences. This review synthesizes recent advances in pediatric MASLD and its severe form, metabolic dysfunction-associated steatohepatitis (MASH), with emphasis on new insights in epidemiology, pathogenesis, and disease burden. Diagnostic evaluation in children remains particularly challenging, requiring integration of clinical, laboratory, imaging, and histologic data, while balancing accuracy, feasibility, and risk. Progress will depend on the development of pediatric-specific tools, equitable access to care, and rigorously designed clinical trials to guide future management.
The nomenclature of steatotic liver disease advanced our understanding of the interplay between alcohol and cardiometabolic risk factors. The new nomenclature introduced a new entity of metabolic dysfunction and alcohol-...The nomenclature of steatotic liver disease advanced our understanding of the interplay between alcohol and cardiometabolic risk factors. The new nomenclature introduced a new entity of metabolic dysfunction and alcohol-associated liver disease or metabolic dysfunction-associated alcohol-related liver disease (MetALD). This brought in challenges like granular self-reported quantification on self-reported alcohol use and changing disease states due to dynamic alcohol use, with risk of misclassification of alcohol use. Given a worldwide increasing prevalence of metabolic syndrome and of alcohol use, this article delves into a global perspective on the challenges and opportunities in the understanding of MetALD.
Metabolic dysfunction-associated steatotic liver disease in lean individuals represents a distinct phenotype affecting approximately 5.1% of the global population, characterized by hepatic steatosis with cardiometabolic...Metabolic dysfunction-associated steatotic liver disease in lean individuals represents a distinct phenotype affecting approximately 5.1% of the global population, characterized by hepatic steatosis with cardiometabolic risk factors despite a normal body mass index. This condition demonstrates unique pathogenic mechanisms, including genetic predisposition, visceral adiposity, and metabolic dysregulation. Prevalence varies globally, with initial recognition in Asian populations, but occurs across diverse ethnicities. Diagnosis relies on imaging modalities and exclusion of secondary causes. Management emphasizes lifestyle interventions targeting 3% to 5% weight reduction. Limited pharmacological data exist, as most clinical trials exclude lean patients. Understanding this population is crucial.
Metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis (MASLD/MASH) is becoming a leading contributor to hepatocellular carcinoma (HCC) globally. This is particularly ev...Metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis (MASLD/MASH) is becoming a leading contributor to hepatocellular carcinoma (HCC) globally. This is particularly evident among adults with HCC undergoing liver transplantation. The majority of patients with MASLD/MASH-related HCC have cirrhosis, but existing data suggest that up to 40% of patients do not have obvious cirrhosis. Early detection of HCC leads to improved curative options, but current guidelines recommend routine HCC surveillance only in patients with cirrhosis. An individualized approach is needed when considering HCC surveillance in MASLD/MASH patients without clinical cirrhosis.
Metabolic dysfunction-associated steatohepatitis (MASH), the progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD), has historically been treated with lifestyle modification (dietary change...Metabolic dysfunction-associated steatohepatitis (MASH), the progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD), has historically been treated with lifestyle modification (dietary changes, exercise and weight loss). While lifestyle modification remains foundational in the treatment of MASLD/MASH, resmetirom (a thyroid hormone β-receptor agonist) and semaglutide (a glucagon-like-peptide-1 receptor agonist) are now Food and Drug Administration-approved for patients with MASH and clinically significant hepatic fibrosis (ie, F2-F3 fibrosis). Emerging therapies will allow for future opportunities at a personalized approach to treatment of MASH. This article reviews currently approved and future regimens for the treatment of MASH and MASH-related cirrhosis.
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly nonalcoholic fatty liver disease, is increasingly prevalent and closely linked to obesity and type 2 diabetes (T2D). These metabolic conditions n...Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly nonalcoholic fatty liver disease, is increasingly prevalent and closely linked to obesity and type 2 diabetes (T2D). These metabolic conditions not only represent drivers of disease progression, but also as therapeutic targets for modifying the disease course. This study reviews the pathophysiological contributions of obesity and T2D to MASLD and evaluates pharmacologic strategies aimed at these drivers. Incretin-based therapies, especially GLP-1 receptor agonists and co-agonists have emerged as leading agents in promoting weight loss, reducing cardiovascular and renal outcomes in T2D and obesity.
Weight reduction (≥5% to improve steatosis and ≥7-10% to improve inflammation and fibrosis) through lifestyle modifications is a first-line treatment of metabolic dysfunction-associated steatotic liver disease. Although...Weight reduction (≥5% to improve steatosis and ≥7-10% to improve inflammation and fibrosis) through lifestyle modifications is a first-line treatment of metabolic dysfunction-associated steatotic liver disease. Although the Mediterranean diet is the most evidence-based and recommended diet, similar plant-based diets are also acceptable. Physical activity and exercise (aerobic and resistance) are effective in steatosis reduction, independent of weight loss. However, the uptake of lifestyle interventions is challenging, and to enhance adherence, clinicians, policymakers, and stakeholders should support individuals by increasing awareness and promoting a healthier environment. Behavioral support, personalization, and sustainability of recommendations are key factors in individualized treatment.
Early identification of patients with metabolic dysfunction-associated steatohepatitis (MASH) and significant fibrosis (≥F2) is critical to optimize patient care and prevent both hepatic and extra-hepatic complications....Early identification of patients with metabolic dysfunction-associated steatohepatitis (MASH) and significant fibrosis (≥F2) is critical to optimize patient care and prevent both hepatic and extra-hepatic complications. Current international guidelines consistently recommend a screening in high-risk populations using 2-step algorithms based on noninvasive tests. This review will examine the recommended risk stratification algorithms for MASH, summarize the evidence supporting their clinical use, and highlight the potential benefits for patient management. Finally, we will discuss the key barriers to their implementation in routine clinical practice.
Patients with metabolic dysfunction-associated steatohepatitis (MASH), particularly those with clinically significant fibrosis (≥F2), are at highest risk for adverse liver outcomes. This narrative review summarizes blood...Patients with metabolic dysfunction-associated steatohepatitis (MASH), particularly those with clinically significant fibrosis (≥F2), are at highest risk for adverse liver outcomes. This narrative review summarizes blood-based scores, imaging tools, and combined indices used to detect and risk stratify patients with MASH and fibrosis. We focus on cutoffs and dynamic trajectories that best capture patients at highest risk for adverse liver events and outline how these noninvasive tests can be integrated into simple stepwise pathways to guide referral and treatment and reduce reliance on liver biopsy.
Metabolic dysfunction-associated steatotic liver disease (MASLD), recently redefined to emphasize its metabolic underpinnings, is emerging as a systemic disorder that extends well beyond the liver. Accumulating evidence...Metabolic dysfunction-associated steatotic liver disease (MASLD), recently redefined to emphasize its metabolic underpinnings, is emerging as a systemic disorder that extends well beyond the liver. Accumulating evidence demonstrates a strong bidirectional association between MASLD, cardiovascular disease (CVD), and chronic kidney disease (CKD). Shared risk factors-including obesity, insulin resistance, hypertension, and dyslipidemia-partly explain this overlap, but common pathogenic mechanisms are increasingly recognized. Hepatic steatosis and inflammation contribute to systemic insulin resistance, atherogenic dyslipidemia, endothelial dysfunction, and a pro-inflammatory, prothrombotic milieu, thereby accelerating cardiovascular injury.
Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a growing global health concern affecting approximately 38% of the adult population worldwide. Beyond its primary hepatic complications, MASLD h...Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a growing global health concern affecting approximately 38% of the adult population worldwide. Beyond its primary hepatic complications, MASLD has emerged as a systemic disorder with significant extrahepatic manifestations. This comprehensive review examines the epidemiologic evidence and pathophysiological mechanisms linking MASLD to extrahepatic malignancies and sarcopenia. Recent meta-analyses demonstrate that MASLD is associated with a 1.3-fold to 2.6-fold increased risk of various cancers, particularly gastrointestinal, breast, and gynecologic malignancies. Additionally, MASLD patients show an approximately 2-fold higher risk of developing sarcopenia, with prevalence rates reaching 23.5%.
Metabolic dysfunction-associated steatohepatitis is a leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation, with the burden rising rapidly in people with type 2 diabetes, prediabetes, and obesi...Metabolic dysfunction-associated steatohepatitis is a leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation, with the burden rising rapidly in people with type 2 diabetes, prediabetes, and obesity. In this mini-review, we summarize recent data on prevalence and regional disparities, and discuss key mechanisms including insulin resistance, lipotoxic injury, organelle stress, immune activation, and fibrogenic signaling. We review advances in noninvasive diagnostics, with emphasis on stepwise strategies using FIB-4 and noninvasive tests such as elastography. Finally, we address cardiovascular risk and systemic inequities that continue to delay diagnosis and limit access to care.
In 2023, new terminology [metabolic dysfunction associated steatotic liver disease (MASLD)] was introduced adressing the shortfalls (stigma/underreporting of alcohol) of nonalcoholic fatty liver disease (NAFLD). MASLD fa...In 2023, new terminology [metabolic dysfunction associated steatotic liver disease (MASLD)] was introduced adressing the shortfalls (stigma/underreporting of alcohol) of nonalcoholic fatty liver disease (NAFLD). MASLD falls within a SLD spectrum dependent upon cardio-metabolic risk factors (CMRFs) and alcohol consumption [MASLD (< 20 g females/30 g males), MetALD (<50g females/<60 g males), and ALD (≥ 50g females/ ≥ 60 g males). HRQL, economic burden, fibrosis, cirrhosis, cancer, and mortality are inversely related with alcohol and presence of multiple CMRFs. Adult prevalence rates of MASLD, Met-ALD and ALD are 30%+, 2.2%-10%, and 1%-3%, respectively. Increased awareness of SLD and decreasing alcohol consumption interventions are needed.