Metabolic Dysfunction-Associated Steatotic Liver Disease: Current Diagnostic Pathways, Noninvasive Fibrosis Assessment, and Therapeutic Strategies

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the current term for steatotic liver disease linked to cardiometabolic dysfunction. In clinical practice, the central task is not simply detecting steatosis but identifying patients with clinically important fibrosis who need closer assessment and treatment intensification. This narrative review summarizes current diagnostic pathways, sequential noninvasive fibrosis assessment, and therapeutic strategies for adults with suspected or confirmed MASLD, based on contemporary guidelines, consensus statements, and key studies. Current recommendations support targeted evaluation of adults with type 2 diabetes, obesity or excess adiposity with metabolic risk factors, unexplained liver enzyme abnormalities, or incidental steatosis. Initial assessment should define the metabolic context, quantify alcohol exposure, and exclude competing liver diseases. Fibrosis risk stratification relies on sequential noninvasive testing, usually beginning with simple blood-based scores and proceeding to elastography or other specialist tests in patients with indeterminate or higher-risk results. Treatment remains centered on weight reduction and cardiometabolic risk management, with additional roles for selected obesity- and diabetes-directed therapies, liver-directed pharmacotherapy in appropriate patients, and bariatric intervention in selected individuals. A fibrosis-focused, stepwise pathway shared across primary care, diabetes and obesity medicine, and hepatology is the most practical current model for MASLD care.