Metabolic dysfunction associated steatotic liver disease: mechanisms, diagnosis, and management in adults
Metabolic dysfunction associated steatotic liver disease: mechanisms, diagnosis, and management in adults
Metabolic dysfunction associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease globally and a major cause of liver related and cardiometabolic morbidity. MASLD is defined by the presence of hepatic steatosis and at least one of five cardiometabolic features in the absence of secondary causes of liver disease and substantial alcohol consumption (>20 g/day for women and 30 g/day for men). The recent reclassification of non-alcoholic fatty liver disease to MASLD represents a paradigm shift towards recognising the central role of systemic metabolic dysfunction and cardiometabolic risk factors in the pathogenesis of the disease and development of complications. The pathophysiology of MASLD is complex, multifaceted, and interconnected, involving adipose tissue dysfunction, altered hepatic lipid metabolism, mitochondrial and endoplasmic reticulum stress, dysregulation of the gut-liver axis, and genetic predisposition. The severity of liver fibrosis remains the strongest predictor of all cause mortality and liver specific morbidity and mortality, and the burden of cardiometabolic dysfunction affects the risk of complications in MASLD. Non-invasive serum based and imaging based biomarkers are crucial in identifying advanced liver fibrosis and guiding risk stratification. This narrative review summarises the current understanding of the pathogenesis of MASLD, the clinical use of non-invasive diagnostics, and compares international guidelines for disease management. This review also discusses approved and emerging treatment options for MASLD, recognising the current need for developing strategies for monitoring the efficacy of treatment.
Diabetes mellitus, Drug therapy, Guideline adherence, Metabolic diseases, Pathology
Reinson, Tina
88ef615c-09ef-4cd5-a60a-d921eed7b6cf
Bilson, Josh
a99f9320-335c-47c8-bf30-07df48a5467d
Childs, Caroline
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Buchanan, Ryan
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Targher, Giovanni
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Byrne, Chrisopher D.
1370b997-cead-4229-83a7-53301ed2a43c
31 March 2026
Reinson, Tina
88ef615c-09ef-4cd5-a60a-d921eed7b6cf
Bilson, Josh
a99f9320-335c-47c8-bf30-07df48a5467d
Childs, Caroline
ea17ccc1-2eac-4f67-96c7-a0c4d9dfd9c5
Buchanan, Ryan
9499f713-f684-4046-be29-83cd9d6f834d
Targher, Giovanni
1a5eeb14-9e56-4835-ac67-276bef232192
Byrne, Chrisopher D.
1370b997-cead-4229-83a7-53301ed2a43c
Reinson, Tina, Bilson, Josh, Childs, Caroline, Buchanan, Ryan, Targher, Giovanni and Byrne, Chrisopher D.
(2026)
Metabolic dysfunction associated steatotic liver disease: mechanisms, diagnosis, and management in adults.
BMJ Medicine, 5 (1), [e002038].
(doi:10.1136/bmjmed-2025-002038).
Abstract
Metabolic dysfunction associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease globally and a major cause of liver related and cardiometabolic morbidity. MASLD is defined by the presence of hepatic steatosis and at least one of five cardiometabolic features in the absence of secondary causes of liver disease and substantial alcohol consumption (>20 g/day for women and 30 g/day for men). The recent reclassification of non-alcoholic fatty liver disease to MASLD represents a paradigm shift towards recognising the central role of systemic metabolic dysfunction and cardiometabolic risk factors in the pathogenesis of the disease and development of complications. The pathophysiology of MASLD is complex, multifaceted, and interconnected, involving adipose tissue dysfunction, altered hepatic lipid metabolism, mitochondrial and endoplasmic reticulum stress, dysregulation of the gut-liver axis, and genetic predisposition. The severity of liver fibrosis remains the strongest predictor of all cause mortality and liver specific morbidity and mortality, and the burden of cardiometabolic dysfunction affects the risk of complications in MASLD. Non-invasive serum based and imaging based biomarkers are crucial in identifying advanced liver fibrosis and guiding risk stratification. This narrative review summarises the current understanding of the pathogenesis of MASLD, the clinical use of non-invasive diagnostics, and compares international guidelines for disease management. This review also discusses approved and emerging treatment options for MASLD, recognising the current need for developing strategies for monitoring the efficacy of treatment.
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Accepted/In Press date: 4 March 2026
Published date: 31 March 2026
Keywords:
Diabetes mellitus, Drug therapy, Guideline adherence, Metabolic diseases, Pathology
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Local EPrints ID: 511355
URI: http://eprints.soton.ac.uk/id/eprint/511355
ISSN: 2754-0413
PURE UUID: db0e599b-dd9e-4f92-a459-1fbb4134c4ae
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Date deposited: 12 May 2026 16:55
Last modified: 16 May 2026 02:10
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Author:
Tina Reinson
Author:
Josh Bilson
Author:
Giovanni Targher
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