Differentiating MASL and MASH: Clinical Insights from Comparative Case Reports in MASLD

Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern. This study aimed to differentiate the clinical features of metabolic dysfunction-associated steatotic liver (MASL) and metabolic dysfunction-associated steatohepatitis (MASH) and evaluate intrahepatic and extrahepatic risk profiles to inform treatment strategies in Korean medicine settings.Methods: Two middle-aged male patients with MASLD-one with MASL and one with MASH-were evaluated for intrahepatic characteristics (steatosis, inflammation, fibrosis) and extrahepatic metabolic risks (comorbidities and cardiovascular indicators).Results: Both patients had severe hepatic steatosis (CAP: 336 and 393 dB/m), obesity, and borderline glycemic profiles. The patient with MASL (51) showed no hepatic inflammation or fibrosis but elevated cardiovascular risk (hs-CRP 4.3 mg/L; LDL 187 mg/dL). The patient with MASH (54) exhibited hepatic inflammation, fibrosis, elevated AST/ALT levels (both 80 IU/L), and increased liver stiffness (LSM: 13.4 kPa).Conclusion: These cases illustrate the MASLD spectrum, underscoring distinct intrahepatic and extrahepatic risk profiles, which may help Korean medicine practitioners recognize subtypes and tailor individualized treatment.