Fatty Liver Disease (MASLD / Metabolic Dysfunction-Associated Steatotic Liver Disease)

Previously known as NAFLD (nonalcoholic fatty liver disease), metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most common chronic liver disease worldwide — affecting approximately 30% of the global population — and is on a trajectory to become the leading cause of cirrhosis and liver transplantation. It exists on a spectrum from simple steatosis (fat accumulation) to MASH (metabolic-associated steatohepatitis, formerly NASH), fibrosis, cirrhosis, and hepatocellular carcinoma. The primary drivers are insulin resistance and excess dietary fructose/refined carbohydrates driving de novo lipogenesis in the liver. Despite its prevalence, MASLD is almost never proactively screened for in primary care — elevated liver enzymes are often attributed to "normal variation" or alcohol use without investigation.