Archives of Advances in Biosciences

Vol. 17 No. 1 (2026)

Metabolic Dysfunction-Associated Steatotic Liver Disease in General Medicine: From Incidental Fatty Liver to Cardiometabolic Risk Stratification

Archives of Advances in Biosciences, Vol. 17 No. 1 (2026), 28 April 2026 , Page 1-8
https://doi.org/10.22037/aab.v17i1.52378

Abstract

Context: Metabolic dysfunction-associated steatotic liver disease (MASLD) has replaced non-alcoholic fatty liver disease in contemporary nomenclature and reframes hepatic steatosis as a multisystem cardiometabolic condition. In general medicine, the usual presentation is incidental steatosis on imaging or mildly abnormal aminotransferases in a patient with obesity, diabetes, hypertension, dyslipidemia, or cardiovascular risk.

Evidence Acquisition: This narrative review was updated through June 2026 using PubMed/MEDLINE, major society guidance, clinical care pathways, systematic reviews, randomized trials, and regulatory sources relevant to adult primary care, internal medicine, endocrinology, obesity medicine, cardiology, and hepatology.

Results: Current evidence supports a pragmatic shift from detecting steatosis alone to identifying clinically significant fibrosis and cardiometabolic risk. MASLD is diagnosed when hepatic steatosis coexists with at least one cardiometabolic risk factor after assessment of alcohol intake and alternative causes of steatosis. Clear separation of MASLD, MetALD, and alcohol-related liver disease is clinically important because alcohol exposure modifies prognosis, counseling, surveillance, and referral needs. Stepwise non-invasive testing, usually beginning with the fibrosis-4 index followed by transient elastography or serum fibrosis testing when indicated, can identify patients who need hepatology referral. Resmetirom and semaglutide have expanded the treatment landscape for selected adults with non-cirrhotic MASH and moderate-to-advanced fibrosis in the jurisdictions where they are approved, but long-term clinical outcome data remain incomplete.

Conclusion: MASLD should be approached as a cardiometabolic risk signal with liver-fibrosis implications. A structured pathway for incidental steatosis can reduce missed advanced fibrosis while improving diabetes, obesity, lipid, blood pressure, cardiovascular, and lifestyle care.

Keywords:
  • Metabolic Dysfunction-Associated Steatotic Liver Disease
  • Metabolic Dysfunction-Associated Steatohepatitis
  • Liver Fibrosis
  • Cardiovascular Risk
  • Non-Invasive Testing
  • Primary Care

How to Cite

Alkhanafsa, M., & Wafi, J. (2026). Metabolic Dysfunction-Associated Steatotic Liver Disease in General Medicine: From Incidental Fatty Liver to Cardiometabolic Risk Stratification. Archives of Advances in Biosciences, 17(1), 1–8. https://doi.org/10.22037/aab.v17i1.52378

References

1. Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multisociety delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542-56. (DOI:10.1016/j.jhep.2023.06.003) (PMID: 37364790)

2. European Association for the Study of the Liver; European Association for the Study of Diabetes; European Association for the Study of Obesity. EASL-EASD-EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. (DOI:10.1016/j.jhep.2024.04.031) (PMID: 38851997)

3. Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, Abdelmalek MF, Caldwell S, Barb D, et al. Aasld practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-835. (DOI:10.1097/HEP.0000000000000323) (PMID: 36727674)

4. Cusi K, Isaacs S, Barb D, Basu R, Caprio S, Garvey WT, et al. American association of clinical endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: co-sponsored by the american association for the study of liver diseases. Endocr Pract. 2022;28(5):528-62. (DOI:10.1016/j.eprac.2022.03.010) (PMID: 35569886)

5. Kanwal F, Bril F, Wong VWS, Adams LA, Pfotenhauer K, Skolnik N, et al. Clinical care pathway for the risk stratification and management of patients with metabolic dysfunction-associated steatotic liver disease. Gastroenterology. 2026;171(1):164-183. (DOI:10.1053/j.gastro.2026.01.047) (PMID: 41812830)

6. Riazi K, Azhari H, Charette JH, Underwood FE, King JA, Ehteshami Afshar E, et al. The prevalence and incidence of nafld worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022;7(9):851-861. (DOI:10.1016/S2468-1253(22)00165-0) (PMID: 35798021)

7. Taylor RS, Taylor RJ, Bayliss S, Hagstrom H, Nasr P, Schattenberg JM, et al. Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis. Gastro. 2020;158(6):1611-25.e12. (DOI:10.1053/j.gastro.2020.01.043) (PMID: 32027911)

8. Ekstedt M, Hagstrom H, Nasr P, Fredrikson M, Stal P, Kechagias S, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatol. 2015;61(5):1547-54. (DOI:10.1002/hep.27368) (PMID: 25125077)

9. Duell PB, Welty FK, Miller M, Chait A, Hammond G, Ahmad Z, et al. Nonalcoholic fatty liver disease and cardiovascular risk: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. 2022;42(6):e168-85. (DOI:10.1161/ATV.0000000000000153) (PMID: 35418240)

10. Mantovani A, Csermely A, Petracca G, Beatrice G, Corey KE, Simon TG, et al. Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: an updated systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(11):903-13. (DOI:10.1016/S2468-1253(21)00308-3) (PMID: 34555346)

11. Mozes FE, Lee JA, Selvaraj EA, Jayaswal ANA, Trauner M, Boursier J, et al. Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis. Gut. 2022;71(5):1006-1019. (DOI:10.1136/gutjnl-2021-324243) (PMID: 34001645)

12. Eddowes PJ, Sasso M, Allison M, Tsochatzis E, Anstee QM, Sheridan D, et al. Accuracy of FibroScan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019;156(6):1717-1730. (DOI:10.1053/j.gastro.2019.01.042) (PMID: 30689971)

13. Younossi ZM, Corey KE, Lim JK. AGA clinical practice update on lifestyle modification using diet and exercise to achieve weight loss in the management of nonalcoholic fatty liver disease: expert review. Gastroenterol. 2021;160(3):912-8. (DOI:10.1053/j.gastro.2020.11.051) (PMID: 33307021)

14. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterol. 2015;149(2):367-78.e5. (DOI:10.1053/j.gastro.2015.04.005) (PMID: 25865049)

15. Lassailly G, Caiazzo R, Ntandja-Wandji LC, Gnemmi V, Baud G, Verkindt H, et al. Bariatric surgery provides long-term resolution of nonalcoholic steatohepatitis and regression of fibrosis. Gastroenterol. 2020;159(4):1290-301.e5. (DOI:10.1053/j.gastro.2020.06.006) (PMID: 32553765)

16. Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010;362(18):1675-85. (DOI:10.1056/NEJMoa0907929) (PMID: 20427778)

17. Harrison SA, Bedossa P, Guy CD, Schattenberg JM, Loomba R, Taub R, et al. A phase 3, randomized, controlled trial of resmetirom in NASH with liver fibrosis. N Engl J Med. 2024;390(6):497-509. (DOI:10.1056/NEJMoa2309000) (PMID: 38324483)

18. Keam SJ. Resmetirom: first approval. Drugs. 2024;84(6):729-735. (doi:10.1007/s40265-024-02045-0) (PMID: 38771485)

19. first treatment for US Food and Drug Administration. FDA approves patients with liver scarring due to fatty liver disease. 2024 Mar 14 [cited 2026 Jun 6]. LINK

20. Chen VL, Morgan TR, Rotman Y, Patton HM, Cusi K, Kanwal F, et al. Resmetirom therapy for metabolic dysfunction-associated steatotic liver disease: October 2024 updates to AASLD practice guidance. Hepatol. 2025;81(1):312-20. (DOI:10.1097/HEP.0000000000001112) (PMID: 39422487)

21. Newsome PN, Buchholtz K, Cusi K, Linder M, Okanoue T, Ratziu V, et al. A placebo-controlled trial of subcutaneous semaglutide in nonalcoholic steatohepatitis. N Engl J Med. 2021;384(12):1113-24. (DOI:10.1056/NEJMoa2028395) (PMID: 33185364)

22. Sanyal AJ, Newsome PN, Kliers I, Noureddin M, Alkhouri N, Harrison SA, et al. Phase 3 trial of semaglutide in metabolic dysfunction-associated steatohepatitis. N Engl J Med. 2025;392(21):2089-99. (DOI:10.1056/NEJMoa2413258) (PMID: 40305708)

23. US Food and Drug Administration. FDA approves treatment for serious liver disease known as MASH. 2025 Aug 15 [cited 2026 Jun 6]. Link

24. Loomba R, Hartman ML, Lawitz EJ, Vuppalanchi R, Boursier J, Bugianesi E, et al. Tirzepatide for metabolic dysfunction-associated steatohepatitis with liver fibrosis. N Engl J Med. 2024;391(4):299-310. (DOI: 10.1056/NEJMx250014) (PMID: 38856224)

  • Abstract Viewed: 14 times
  • PDF Downloaded: 2 times

Download Statastics

Developed By

Open Journal Systems

Information