Context:

In recent times, Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is emerging as a major public health concern in India.

About MASLD:

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly known as Nonalcoholic Fatty Liver Disease (NAFLD), is a common, often silent, condition characterized by excess fat buildup in the liver linked to metabolic factors like obesity, type 2 diabetes, and insulin resistance. Affecting about 30% of adults globally, it is frequently reversible in early stages through weight loss, diet, and exercise, but can progress to cirrhosis, liver failure, or cancer if unmanaged.

About Risk Factors:

MASLD affects a substantial proportion of the Indian population. Indian studies suggest that approximately one-third of adults may be affected, with higher rates among those with metabolic syndrome.

Key risk factors include:

·         Overweight or obesity

·         Type 2 diabetes

·         Hypertension

·         Elevated cholesterol and triglyceride levels

·         Sedentary lifestyle

The disease is strongly associated with insulin resistance and other components of metabolic syndrome, making early detection critical to prevent progression.

Pathophysiology and Progression:

MASLD involves fat accumulation in liver cells, which can trigger inflammation and scarring if untreated. It progresses through:

1.       Steatosis – Fat deposition without inflammation.

2.      Steatohepatitis – Liver cell inflammation.

3.      Fibrosis – Scar tissue formation.

4.     Cirrhosis – Advanced scarring, with risk of liver failure and cancer.

Early MASLD is often silent, and liver function tests may remain normal, complicating diagnosis.

Management and Treatment:

MASLD is largely manageable through lifestyle changes:

• • • • Diet: Emphasize whole foods, fruits, vegetables, lean proteins; reduce refined carbs, sugary drinks, and processed foods; prefer multigrain staples.
      • Weight management: 7–10% body weight loss improves liver fat and function.
      • Physical activity: Combine aerobic and strength training; reduce sedentary time and incorporate short active breaks (NEAT).
      • Sleep & fasting: 7–8 hours sleep; intermittent fasting (16:8 or 14:10) under supervision.

Medical management (for diabetes, cholesterol) and bariatric surgery may be used in severe cases.

Public Health Implications:

MASLD is a growing public health challenge in India due to obesity, sedentary lifestyles, and dietary shifts. Awareness, screening, workplace wellness programmes, and early interventions can reduce risks of cirrhosis, liver cancer, and cardiovascular complications.

Conclusion:

MASLD is preventable and manageable. Its reclassification from NAFLD emphasizes the link between metabolic health and liver function. Early screening, lifestyle modification, and public health measures are key to controlling this silent epidemic.