Hepatic steatosis: A pandemic disease causing serious secondary diseases

BACKGROUND: At least one-quarter of the world's population now suffers from hepatic steatosis (fatty liver disease), which, in current terminology, is called metabolic dysfunction-associated steatotic liver disease (MASLD). This disease and its more dangerous inflammatory variant, metabolic dysfunction-associated steatohepatitis (MASH), promote the development of serious secondary conditions including cardiovascular diseases (CVDs), type 2 diabetes mellitus, and hepatocellular carcinoma (HCC). METHODS: This review is based on pertinent publications retrieved from the PubMed-MEDLINE and Google Scholar databases and on current guidelines. RESULTS: Conditions that are known to be associated with MASLD and/or MASH include obesity (with or without insulin resistance), dyslipidemia, hypertension, type 2 diabetes mellitus, obstructive sleep apnea, CVDs, and chronic kidney disease (CKD). The frequency of serious secondary diseases (CVDs, CKD, HCC, and extrahepatic malignancies) increases with the degree of fibrosis progression. Cardiovascular events are the main cause of death. Intensive lifestyle changes, including a hypocaloric, low-sugar diet and physical activity and exercise in an adequate amount and intensity, are the first line of treatment and the basis for further treatment options (resmetirom, incretin analogues, bariatric surgery). CONCLUSION: In view of its high prevalence and its associated profile of elevated cardiovascular risk, MASLD should be recognized as clinical evidence of the danger of major secondary disease and integrated into a structured, interdisciplinary management program with strict risk stratification. Drugs are part of the therapeutic spectrum but are no substitute for lifestyle modification, which remains the basis of treatment.