Pathophysiology of depression and anxiety in metabolic dysfunction-associated steatotic liver disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease with a continually rising global prevalence and significant mortality rates. Emerging evidence suggests a strong association between MASLD and mental health disorders such as depression and anxiety. In addition to the shared risk factors such as obesity, type 2 diabetes and insulin resistance which contribute to this relationship through mechanisms involving systemic inflammation and oxidative stress; other pathophysiological mechanisms such as dysregulation of hypothalamic-pituitary-adrenal axis, neurotransmitter imbalances and gut dysbiosis have also been proposed to play a significant role. The current paper aims to review the pathophysiological mechanisms underlying the association between MASLD and mood disorders such as depression and anxiety. We note a bidirectional relationship between these two disorders, and the dual burden of both these disease processes can be alleviated by early detection and encouraging a more proactive and holistic approach through diet and lifestyle changes. This review summarizes the existing literature on association between MASLD and depression.