Metabolic dysfunction associated steatotic liver disease in patients with cardiometabolic risk
DOI:
https://doi.org/10.59652/qwa8f058Keywords:
Metabolic dysfunction-associated steatotic liver disease, MASLD, MASH, obesity, type 2 diabetes, cardiovascular disease, fibrosis assessment, FIB-4, transient elastography, cardiometabolic riskAbstract
Metabolic dysfunction-associated steatotic liver disease has become one of the most common liver disorders encountered in general medicine, endocrinology, cardiology, obesity medicine, and primary care. The change from non-alcoholic fatty liver disease to metabolic dysfunction-associated steatotic liver disease reflects an important clinical shift: hepatic steatosis is now understood less as an isolated liver finding and more as part of a wider metabolic disorder. Patients with obesity, type 2 diabetes, hypertension, dyslipidaemia, cardiovascular disease, and chronic kidney disease carry a particularly high burden of steatosis, metabolic dysfunction-associated steatohepatitis, and clinically significant fibrosis. This review examines metabolic dysfunction-associated steatotic liver disease in patients with cardiometabolic risk, with specific attention to obesity, type 2 diabetes, cardiovascular disease, screening pathways, fibrosis assessment, and referral criteria. PubMed-indexed guidelines, systematic reviews, meta-analyses, cohort studies, and randomized trials were reviewed. Current evidence supports a risk-based approach rather than indiscriminate population screening. Patients with type 2 diabetes, obesity with additional metabolic risk factors, persistently abnormal liver enzymes, imaging evidence of steatosis, or clinical suspicion of advanced liver disease should undergo structured case-finding for fibrosis. Simple blood-based scores such as fibrosis-4 can be used as first-line tools, followed by elastography or enhanced liver fibrosis testing when results are indeterminate or high. Fibrosis stage remains the strongest predictor of liver-related outcomes and is also associated with broader mortality risk. Management should combine weight loss, treatment of diabetes and dyslipidaemia, cardiovascular risk reduction, alcohol assessment, and timely referral for specialist evaluation when advanced fibrosis or cirrhosis is suspected. Metabolic dysfunction-associated steatotic liver disease should no longer be treated as an incidental radiology phrase. In patients with cardiometabolic risk, it is a marker of systemic disease and a practical opportunity for early risk stratification.
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