Emerging Perspectives in the Diagnosis and Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Narrative Review.

Metabolic dysfunction-associated steatotic liver disease (MASLD, previously known as non-alcoholic fatty liver disease (NAFLD)) has emerged as the most prevalent chronic liver condition, affecting approximately 25% of the global population. The disease encompasses a spectrum ranging from simple steatosis to metabolic dysfunction-associated steatohepatitis (MASH, previously known as non-alcoholic fatty liver disease (NASH)), fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Despite its growing burden, MASLD remains under-recognized in public health discussions. This review explores the epidemiology, pathophysiology, diagnostic advancements, and management strategies for MASLD. Recent developments in noninvasive diagnostic modalities, including imaging techniques like magnetic resonance imaging proton density fat fraction (MRI-PDFF) and elastography, as well as emerging biomarkers such as CK-18 and thrombospondin-2, offer promising alternatives to liver biopsy. In terms of management, lifestyle interventions remain the cornerstone of therapy, while pharmacological approaches such as GLP-1 receptor agonists, SGLT-2 inhibitors, and FXR agonists are being actively explored. Additionally, bariatric surgery has demonstrated efficacy in select populations. Given the complex interplay between metabolic, genetic, and environmental factors in MASLD pathogenesis, a multidisciplinary approach is essential. Recent advancements in noninvasive diagnostic techniques (such as FibroScan and MRI-PDFF) for MASLD have significantly improved the assessment of liver steatosis and fibrosis. These tools, among others, have transformed the diagnostic landscape of MASLD, reducing reliance on liver biopsies. Despite these advancements, there remains a need for comprehensive reviews that integrate these diagnostic modalities with emerging therapeutic strategies, such as the increasing use of GLP-1 receptor agonists and SGLT-2 inhibitors. This review aims to bridge this gap by synthesizing current knowledge on noninvasive diagnostics and emerging treatment strategies, identifying ongoing challenges in the field, and highlighting opportunities for personalized care. This provides clinicians with an up-to-date and practical resource for managing MASLD.