Obesity and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Literature Review on Pathophysiology and Treatment - PubMed
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- #liver disease
- MASLD is a key hepatic manifestation of obesity and systemic metabolic dysfunction, and a leading cause of chronic liver disease globally.
- Obesity-driven mechanisms such as adipose tissue dysfunction, insulin resistance, and increased free fatty acid flux promote liver fat accumulation and lipotoxic injury.
- Disease progression from steatosis to steatohepatitis, fibrosis, and cirrhosis involves mitochondrial/ER stress, inflammation, immune activation, and gut-liver axis disturbances.
- MASLD is highly heterogeneous with distinct phenotypes like lean and non-lean MASLD, influenced by fat distribution, body composition, and genetic susceptibility.
- Fibrosis stage is the strongest predictor of liver-related and all-cause mortality, highlighting the need for early recognition and risk stratification.
- Therapeutic strategies focus on upstream metabolic drivers; lifestyle interventions are foundational but limited by adherence challenges.
- Pharmacologic therapies, especially incretin-based agents (e.g., GLP-1 receptor agonists), and bariatric/endoscopic procedures show substantial metabolic and hepatic benefits.
- Phenotype-guided approaches integrating metabolic risk, adiposity, body composition, and fibrosis assessment are recommended for personalized treatment and improved outcomes.