Predictive factors of MASLD in young adults: A systematic review and narrative synthesis

Metabolic dysfunction-associated steatotic liver disease (MASLD) in young adults is an emerging public health concern influenced by a multitude of demographic, lifestyle, metabolic, genetic, and environmental factors.

A systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted using PubMed, Wiley Online Library, and Cochrane Library. Studies investigating the predictors of metabolic dysfunction-associated steatotic liver disease in young adults aged 18-45 years were included. Methodological quality was assessed using the JBI checklist, and the adapted GRADE system was employed to evaluate the quality of evidence.

The review identified 43 factors positively associated with MASLD, and 9 factors negatively associated with MASLD among young adults. The most consistent risk factors were metabolic abnormalities, such as obesity, insulin resistance, and dyslipidemia. Lifestyle behaviors, particularly poor dietary habits, physical inactivity, and prolonged screen time, are also strongly associated with MASLD. Additionally, genetic predisposition and environmental influences have been implicated. Conversely, the protective factors included higher levels of physical activity, adherence to healthy dietary patterns, and favorable metabolic profiles. The quality of evidence varied across the predictors, underscoring the need for further high-quality studies.

The findings highlight the multidimensional nature of MASLD in young adults, which is driven by metabolic, lifestyle, and genetic determinants. Early identification of high-risk individuals and targeted lifestyle interventions are crucial to reduce the future burden of this disease.