Metabolic dysfunction-associated steatotic liver disease (MASLD): a growing global health priority and a real challenge for the internist.

Metabolic dysfunction-associated steatosis liver disease (MASLD) has emerged as the most prevalent chronic liver disease worldwide, reflecting the global rise in metabolic disorders, such as obesity and type 2 diabetes mellitus. The transition from the term non-alcoholic fatty liver disease (NAFLD) to MASLD represents a conceptual shift toward a pathophysiology-based definition centered on metabolic dysfunction. MASLD encompasses a disease spectrum ranging from simple steatosis to metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, and hepatocellular carcinoma. Importantly, MASLD is not confined to hepatic manifestations but is strongly associated with cardiovascular disease, chronic kidney disease, and other systemic complications. Despite its high prevalence and clinical impact, MASLD remains underdiagnosed due to its asymptomatic nature in early stages and limitations in screening strategies. This manuscript reviews epidemiology, pathophysiology, clinical implications, diagnostic challenges, and therapeutic approaches related to MASLD, emphasizing the urgent need for increased awareness, early detection, and multidisciplinary management. Addressing MASLD is essential not only to reduce liver-related morbidity and mortality but also to mitigate the broader burden of metabolic disease on global health systems.