Metabolic Steatotic Liver Disease in Adults: A Comprehensive Review

Metabolic dysfunction–associated steatotic liver disease (MASLD) ranges from isolated steatosis to metabolic dysfunction–associated steatohepatitis (MASH), the latter being characterized by fat accumulation and inflammation. MASLD poses increased risks for liver complications, hepatocellular carcinoma, cardiovascular disease, and some extrahepatic cancers. It is prevalent in 30–40% of adults and particularly among those with type 2 diabetes (60–70%) and obesity (70–80%). Diagnosis often begins with an ultrasound indicating liver fat accumulation.

To confirm Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), patients must exhibit at least one metabolic syndrome feature, including excess abdominal fat, prediabetes or type 2 diabetes, high blood pressure, elevated triglycerides, or low HDL cholesterol. Low alcohol intake is also essential, with limits set at 140 g/week for women and 210 g/week for men. Additional conditions such as certain medications, hepatitis C, or iron overload should be excluded. Risk increases with age above 50 and male gender. Fibrosis staging may utilize the Fibrosis-4 index, which considers age, liver enzyme levels, and platelet count, or noninvasive techniques like vibration-controlled transient elastography. Cardiovascular disease is the primary cause of death in MASLD, followed by extrahepatic cancers and liver-related complications.

Treatment for MASLD primarily involves lifestyle changes, including regular exercise, maintaining a healthy weight, low-calorie diets, and avoiding alcohol, along with managing diabetes, obesity, hypertension, and dyslipidemia. Bariatric surgery is an option for patients with a body mass index over 35. Additionally, the FDA has conditionally approved Resmetirom, a thyroid hormone receptor β agonist, and subcutaneous semaglutide, a glucagon-like peptide-1 receptor agonist, for adults with MASH and moderate-to-advanced fibrosis.

Thus to conclude, the review outlines that MASLD is highly prevalent worldwide and requires a combination of lifestyle interventions and targeted therapies to reduce morbidity and mortality.

References:

1. Tilg H, Petta S, Stefan N, et al. Metabolic dysfunction–associated steatotic liver disease in adults: a review. JAMA. 2025 Nov 10. doi:10.1001/jama.2025.19615.; https://jamanetwork.com/journals/jama/article-abstract/2841071