Hidden Hunger: A Forgotten Comorbidity of Metabolic-Syndrome-Associated Fatty Liver Disease

Metabolic-syndrome-associated fatty liver disease (MAFLD), formally recognized as non-alcoholic fatty liver disease (NAFLD), is a growing global health challenge. MAFLD or NAFLD (M/NAFLD) pathophysiology is characterized by excessive fat accumulation in the liver, often driven by metabolic disorders such as obesity, insulin resistance, and dyslipidemia. Micronutrient deficiencies known as "hidden hunger" remain an underexplored comorbidity of M/NAFLD. Hidden hunger, caused by inadequate intake or poor bioavailability of essential vitamins and minerals, can exacerbate the pathophysiology of M/NAFLD through mechanisms such as oxidative stress, inflammation, and impaired lipid metabolism. This review examined the intricate interconnection between hidden hunger and M/NAFLD. Key micronutrients (vitamins D, E, A, and C, zinc, selenium, and magnesium) are critical in maintaining metabolic homeostasis and mitigating liver damage. Their deficiencies can accelerate M/NAFLD progression from simple steatosis to advanced stages like non-alcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma. We also highlight the diagnostic challenges posed by overlapping symptoms of hidden hunger and M/NAFLD and emphasize the need for comprehensive screening protocols. Evidence-based therapeutic strategies, including nutritional interventions and micronutrient supplementation, were explored for their potential to halt or reverse disease progression. We maintained that addressing hidden hunger offers a special chance to enhance results in M/NAFLD patients.