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REVIEW ARTICLE

Recent advances in metabolic dysfunction-associated steatotic liver disease

Amedeo Lonardo1* ,  Mohamad Jamalinia2 ,  Ralf Weiskirchen3
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1 Independent Researcher, Modena, Italy
2 Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
3 Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH Aachen University Hospital, Aachen, North Rhine-Westphalia, Germany
EJMO, 026070085 https://doi.org/10.36922/EJMO026070085
Received: 14 February 2026 | Revised: 13 March 2026 | Accepted: 18 March 2026 | Published online: 28 April 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD), commonly associated with obesity and type 2 diabetes mellitus, is characterized by excess intrahepatic fat and is accompanied by at least one metabolic risk factor, without significant alcohol consumption. It is a major etiology of chronic liver disease—including metabolic dysfunction-associated steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma—contributing substantially to liver-related morbidity and mortality. Accumulating evidence supports the notion that MASLD is a systemic condition with an increased risk of extrahepatic outcomes, including incident type 2 diabetes mellitus, cardiovascular disease, and various extrahepatic cancers. This review critically examines recent advances in key MASLD topics, including evolving clinical trial endpoints, novel insights into pathogenesis, genetic and non-genetic disease modifiers, cancer risk, and emerging pharmacological therapies. The review concludes that advances in disease stratification, biomarkers, and artificial intelligence may enhance patient care and research. With the rapid global rise in metabolic disorders, MASLD and metabolic dysfunction-associated steatohepatitis should be prioritized in health policy agendas. These conditions pose a challenge for clinical trial recruitment and patient management and should be integrated into the broader noncommunicable disease framework to prevent millions of avoidable cases and support goals to reduce premature noncommunicable disease deaths by 2030.

Keywords
Hypertension
Biomarkers
Genetics
Liver histology
Pathogenesis
Pharmacotherapy
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
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