MASLD- Global prevalence, pathophysiological processes and management pathways- tackling a complex problem

Abstract

Metabolic dysfunction associated steatotic liver disease (MASLD), is characterised by deposition of fat in liver which can be associated with necroinflammation and fibrogenesis, which may progress to liver cirrhosis or hepatocellular carcinoma (HCC). This review intends to highlight the increasing prevalence, increasing data on genetic predisposition, gut microbiome and pathophysiological processes involved in the complex interplay for development of MASLD. The complex pathways also highlight the association of MASLD with cardiometabolic disorders like diabetes, atherosclerotic heart disease and dyslipidaemia particularly for hypertriglyceridemia. It also reviews briefly the diagnostic tools available in assessing the disease as well as lays outlay for the management of MASLD by various means including lifestyle interventions, pharmacotherapy and surgical options. Endoscopic and surgical weight management therapies have also been shown to be effective in MASLD. However, access and acceptability remain poor for these weight reduction methods. The developments in the integrated management of MASLD have been fairly encouraging with many programs encompassing lifestyle modifications and pharmacological interventions together. Further well-designed long-term prospective studies should be undertaken to generate evidence with definitive results.