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Publications

Journal Article Review Epublish

PubMed: 40734888 DOI: 10.7759/cureus.86963

Pathological Evolution and Internal Medicine Management of Nonalcoholic Fatty Liver Disease (NAFLD) in the Era of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).

Cureus 17(6):e86963

Authors: Muhammad Moseeb Ali Hashim, Muhammad Aizaz Mohsin Khan, Muhammad Usama Ashraf, Saniya Mohsin, Kamran Zahoor, Javeria Niazi, Aiza Khan, Sania Muzaffar, Madiha Makhdumi, Omar Ahmed Ibad, Talha Kamran Khan, Sohaib Khalid

Affiliations

  • Pathology and Laboratory Medicine, University of Missouri-Columbia, Columbia, USA.
  • School of Medicine, The University of Buckingham, Buckingham, GBR.
  • Internal Medicine, Changsha Medical University, Changsha, CHN.
  • Internal Medicine, Baqai Medical University, Karachi, PAK.
  • Pathology, Allama Iqbal Medical College, Lahore, PAK.
  • Pathology and Laboratory Medicine, Dow University of Health Sciences, Karachi, PAK.
  • Pathology and Laboratory Medicine, Baylor Univeraity Medical Center, Dallas, USA.
  • Pathology and Laboratory Medicine, Shifa College of Medicine, Islamabad, PAK.
  • Pathology and Laboratory Medicine, University of California Davis Health System, Sacramento, USA.
  • Histopathology, Chughtai Institute of Pathology, Lahore, PAK.

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease (NAFLD), is now recognized as the most prevalent chronic liver disease worldwide, driven by the rise in obesity, type 2 diabetes, and metabolic syndrome. The evolving nomenclature and understanding of MASLD necessitate updated insights into its pathophysiology, diagnostics, and internal medicine management. A comprehensive literature review was conducted using PubMed, Scopus, Web of Science, and Cochrane databases for articles published between 2018 and 2025. Eligible studies included human-based clinical or translational research addressing MASLD pathogenesis, diagnostics, and management. Non-invasive scoring systems, pharmacotherapies, and multidisciplinary management strategies were evaluated. The pathological progression of MASLD spans from simple steatosis to steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Key pathogenic mechanisms involve insulin resistance, adipokine imbalance, gut-liver axis dysregulation, and genetic polymorphisms such as PNPLA3. Diagnostic approaches have shifted toward non-invasive tools, including Fibrosis-4 (FIB-4), NAFLD Fibrosis Score, Enhanced Liver Fibrosis (ELF) score, Vibration-Controlled Transient Elastography (VCTE), and magnetic resonance imaging-proton density fat fraction (MRI-PDFF). Lifestyle modification remains the cornerstone of management, but promising pharmacologic therapies, such as glucagon-like peptide-1 (GLP-1) receptor agonists, vitamin E, pioglitazone, and resmetirom, are emerging. Multidisciplinary risk factor control, including diabetes, lipid, and blood pressure management, is critical. Emerging biomarkers and multi-omics technologies, alongside artificial intelligence, are redefining MASLD stratification and therapeutic monitoring. Early identification and comprehensive management of MASLD are essential to prevent advanced liver disease and associated comorbidities. With evolving nomenclature, non-invasive diagnostics, and emerging therapies, internal medicine practitioners must adopt an integrative, multidisciplinary approach to care. Future research should prioritize personalized treatment strategies and health system integration to address the growing MASLD burden.

MeSH

Liver Diseases, Diabetes Mellitus, Glucagon-Like Peptide 1, Internal Medicine, Non-Alcoholic Fatty Liver Disease, Multiple Chronic Conditions, Liver, Research, Therapeutics, Fatty Liver