Lean metabolic dysfunction-associated steatotic liver disease

PURPOSE OF REVIEW: Lean metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as an important but often overlooked condition. A normal BMI does not necessarily mean a low risk of liver or metabolic disease, making early recognition particularly important. RECENT FINDINGS: Lean MASLD can develop through a combination of visceral fat, insulin resistance, loss of muscle mass, genetic factors, and changes in the gut-liver axis. Conventional BMI-based assessment can miss those at risk of liver fibrosis and cardiovascular complications. Emerging metabolic and genetic markers may improve early detection and risk assessment. SUMMARY: Lean MASLD should not be regarded as a benign form of fatty liver disease, as it can still carry significant hepatic and cardiometabolic risks. Management should focus on healthy diet, regular aerobic and resistance exercise, maintaining muscle mass, assessing liver fibrosis, and reducing cardiovascular risk. Further research is needed to develop practical tools for earlier diagnosis and personalized treatment.