Lean metabolic dysfunction-associated steatotic liver disease: Current insights and knowledge gaps

Area of Science:

• Hepatology
• Metabolic Disorders
• Epidemiology

Background:

• Metabolic dysfunction-associated liver disease (MASLD) is increasing worldwide.
• Lean MASLD, a subtype affecting 10-20% of MASLD patients, is more prevalent in Asian populations.
• Factors like thin-fat phenotype, visceral adiposity, insulin resistance, and genetics contribute to lean MASLD.

Purpose of the Study:

• To review the characteristics, comorbidities, and risks associated with lean MASLD.
• To discuss current diagnostic approaches and emerging treatments for lean MASLD.
• To highlight the need for further research into lean MASLD pathogenesis, diagnostics, and management.

Main Methods:

• Literature review of studies on lean MASLD.
• Analysis of epidemiological data on lean MASLD prevalence.
• Synthesis of information on clinical presentation, comorbidities, and outcomes.

Main Results:

• Lean MASLD patients exhibit a distinct profile with co-existing conditions like diabetes and cardiovascular disease.
• Despite lower comorbidity burden than non-lean MASLD, lean MASLD is associated with higher rates of advanced fibrosis and all-cause mortality.
• Current diagnostic tools show emerging performance data in lean MASLD populations.

Conclusions:

• Lean MASLD represents a high-risk group requiring targeted research and management strategies.
• Lifestyle modifications and specific agents show promise, but further therapeutic development is needed.
• Additional studies are crucial to understand lean MASLD pathogenesis, optimize diagnostics, and improve long-term patient outcomes.