Metabolic dysfunction-associated steatotic liver disease in Egypt: Epidemiology, risk factors and management challenges.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a major contributor to liver-related morbidity and mortality worldwide, with Egypt carrying one of the highest national burdens in the Middle East and North Africa region. This narrative review explores the epidemiological landscape, pathophysiological drivers, diagnostic challenges, and therapeutic gaps of MASLD in Egypt, emphasizing its complex interplay with unique local factors. High rates of obesity, type 2 diabetes, and sedentary lifestyle, combined with dietary transitions, socioeconomic disparities, and residual hepatic injury from prior hepatitis C virus infection, have positioned MASLD as a growing public health concern. Despite this, awareness of the disease remains limited among both the public and healthcare providers. Diagnostic approaches are largely restricted to conventional ultrasound and non-invasive scoring systems, with limited access advanced imaging modalities including elastography in routine practice. While lifestyle modification remains the cornerstone of treatment, adherence is low, and pharmacologic and surgical options are often inaccessible due to cost and systemic limitations. Furthermore, stigmatization and knowledge gaps contribute to delayed care and fragmented management. The absence of national guidelines, screening strategies, and integrated care models continues to impede effective disease control. Addressing MASLD in Egypt requires a coordinated public health response that integrates MASLD into broader non-communicable disease strategies. Future efforts should prioritize the development of national diagnostic and treatment pathways, population-based screening for high-risk individuals, enhanced provider education, and research into genetic and environmental determinants of disease progression. Without targeted intervention, MASLD threatens to become the next silent epidemic in Egypt's evolving liver disease landscape.