Genetics of Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD) in the Indian Ethnicity: An Update

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is on the rise alongside other noncommunicable diseases including type-2 diabetes and obesity. It is a continuum of disease that starts with simple infiltration of fat in the liver and may progress to metabolic dysfunction-associated steatohepatitis (MASH), cirrhosis and hepatocellular carcinoma. Recently the US Food and Drug Administration approved a drug (Rezdiffra/resmetirom) for the treatment of adults with noncirrhotic, MASH with moderate to advanced liver fibrosis. This is the only approved drug for the condition, and the medication is advised to be taken along with diet and exercise. In this context the mainstay of treatment continues to be diet and exercise, therefore the emphasis is on early detection. Genetic susceptibility in the form of genetic variants is reliable and has the ability to predict the future onset of the disease. Understanding the genetic susceptibility very early in life and modifying diet and lifestyle accordingly are the best way forward to minimize the risk of progressing to more advanced stages of the disease. This review summarizes the genetic studies carried out in the Indian ethnicity that confer higher risk of/or protection against MASLD.