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Clinical Advances in Metabolic Dysfunction-Associated Steatotic Liver Disease

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 20 December 2025 | Viewed by 4824

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Special Issue Editor

Dr. Hirsh D. Trivedi

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Guest Editor

Karsh Division of Gastroenterology & Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Interests: IM gastroenterology; hepatology; nonalcoholic fatty liver disease
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Special Issue Information

Dear Colleagues,

It is my pleasure to invite you to contribute to this Journal of Clinical Medicine Special Issue entitled “Clinical Advances in Metabolic Dysfunction-Associated Steatotic Liver Disease”. As you know, the incidence and prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is on the rise. Indeed, this condition is afflicting the global population and is projected to become the leading cause of liver transplantation in the next decade or less. Patients with MASLD are suffering from increasingly worse outcomes, making MASLD a significant burden to our patients, the economy, and healthcare systems as a whole.

As the Guest Editor of this Special Issue, I look forward to accepting and publishing articles that highlight novel concepts for MASLD diagnosis and management to increase awareness and optimize management protocols. The journal and I thank you in advance for your contribution.

Dr. Hirsh D. Trivedi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

metabolic dysfunction-associated steatotic liver disease
MASLD
non-alcoholic fatty liver disease
NAFLD
liver disease
liver fibrosis
metabolic syndrome

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Published Papers (5 papers)

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Research

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12 pages, 447 KB

Open AccessArticle

The Impact of Social Determinants of Health on Metabolic Dysfunction-Associated Steatotic Liver Disease Among Adults in the United States

by Vidhi Singh, Susan Cheng, Amanda Velazquez, Hirsh D. Trivedi and Alan C. Kwan

J. Clin. Med. 2025, 14(15), 5484; https://doi.org/10.3390/jcm14155484 - 4 Aug 2025

Viewed by 715

Abstract

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease. It has known multifactorial pathophysiology, but the impact of social determinants of health (SDOH) on the rising prevalence of MASLD is poorly understood. We conducted a retrospective cross-sectional study to examine the influence of SDOH on MASLD using nationwide data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES) study. Methods: We identified participants with MASLD based on liver ultrasound-based controlled attenuation parameter measurements consistent with diagnostic guidelines. We then used logistic regression models to examine associations between SDOH variables and MASLD, with a pre-specified focus on education and income, sequentially adjusting for sociodemographic factors, medical comorbidities, and other SDOH. Results: Our study found that higher education (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.62–0.97, p = 0.024) but not higher income (OR 1.12, 95% CI 0.91–1.37, p = 0.3) was associated with lower odds of MASLD in multivariable adjusted models. We also identified a significant interaction between education level and food security, as well as interactions between food security and other significant SDOH. In the stratified analyses, higher education was significantly associated with lower odds of MASLD among participants with food security (OR 0.71, 95% CI 0.55–0.91, p = 0.007) but not among those with food insecurity (OR 1.26, 95% CI 0.76–2.11, p = 0.4). Conclusions: Our findings identify the potential impact of SDOH on odds of MASLD and suggest increased importance of food security relative to other SDOH. Full article

(This article belongs to the Special Issue Clinical Advances in Metabolic Dysfunction-Associated Steatotic Liver Disease)

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12 pages, 797 KB

Open AccessArticle

Comparison Between Transient Elastography and Point Shear Wave Elastography in the Assessment of Liver Fibrosis According to the Grade of Liver Steatosis

by Giuseppe Losurdo, Antonino Castellaneta, Claudia Di Nuccio, Paola Dell’Aquila, Ilaria Ditonno, Domenico Novielli, Antonio Continisio, Margherita De Bellis, Alfredo Di Leo, Mariabeatrice Principi and Michele Barone

J. Clin. Med. 2025, 14(15), 5417; https://doi.org/10.3390/jcm14155417 - 1 Aug 2025

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Abstract

Background: Transient elastography (TE), using Fibroscan^® and point shear wave elastography (pSWE), are two techniques used to estimate liver fibrosis. The aim of our study was to compare, for the first time, these two techniques in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), stratifying the analysis on the basis of the grades of steatosis. Methods: We recruited 85 consecutive MAFLD patients who underwent liver stiffness (LS) measurement performed by Fibroscan^® and pSWE on the same day. Severity of steatosis was estimated by Fibroscan^® and expressed as controlled attenuation parameter (CAP), ranging from S0 to S3. Spearman’s “r” coefficient was used to calculate the correlation and Bland–Altman graphs was used to evaluate the agreement. Results: In general, the correlation and agreement between Fibroscan^® and pSWE were substantial (r = 0.66, p < 0.001 and bias= −0.64 ± 2.48, respectively). When data were analyzed according to the grade of steatosis, an increasing significant correlation was observed going from S0 to S2 (r = 0.79, r = 0.81, and r = 0.85, respectively), whereas a low correlation and agreement were observed for S3 patients (r = 0.48, p = 0.003, bias= −0.95 ± 2.51). Conclusions: Fibroscan^® and pSWE are equivalent techniques to estimate liver fibrosis in patients with mild to moderate steatosis, while in presence of severe steatosis their agreement is low. Full article

(This article belongs to the Special Issue Clinical Advances in Metabolic Dysfunction-Associated Steatotic Liver Disease)

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14 pages, 1678 KB

Open AccessArticle

Evaluation of Defensins as Markers of Gut Microbiota Disturbances in Children with Obesity and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

by Aldona Wierzbicka-Rucińska, Ewa Konopka, Sebastian Więckowski, Wojciech Jańczyk, Anna Świąder-Leśniak, Jolanta Świderska, Joanna Trojanek, Zbigniew Kułaga, Piotr Socha and Joanna Bierła

J. Clin. Med. 2025, 14(10), 3505; https://doi.org/10.3390/jcm14103505 - 16 May 2025

Cited by 2 | Viewed by 830

Abstract

Until recently, it was believed that bacterial translocation occurs as a result of leaky gut syndrome or sepsis. To confirm or exclude the process of bacterial translocation, biomarkers can be used. One such biomarker is defensins, which indicate immune activity, as defensins are cationic peptides with antibacterial properties produced by intestinal epithelial cells. Also, fatty acid-binding proteins (I-FABP and L-FABP) can serve as useful serological markers for intestinal epithelial damage, indicating impaired intestinal permeability or organ damage, as high concentrations of them are found in tissues and low concentrations in blood serum. In the context of obesity, the integrity of the intestinal barrier, which can be disrupted by dietary fat, leads to increased intestinal permeability. Since bacterial translocation and microbiota contribute to obesity and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) associated with metabolic dysfunction, intestinal barrier markers can be used to study the role of the gut–liver axis. The aim of this study was to gain insight into the pathogenesis of MASLD and examine the impact of bacterial translocation markers and intestinal and hepatic fatty acid-binding proteins (I-FABP and L-FABP) in children with MASLD. Method: We examined 60 children with MASLD and overweight/obesity (MASLD was diagnosed based on increased liver echogenicity in ultrasound and elevated ALT activity), aged 14.5 years (range 8.5 to 15.8); 33 children with overweight/obesity without MASLD, aged 13.0 years (range 11.4 to 15.8); and 16 healthy controls aged 11.0 years (range 7.0 to 16.2). Defensin, I-FABP, and L-FABP levels were measured using commercial kits: ELISA kits (Drg Medtek) were used to assess α-5 and α-6 defensin concentrations (HBD5, HBD6). I-FABP and L-FABP concentrations were measured using commercial ELISA kits (Hycult Biotech Inc., Wayne, PA, USA). ANOVA analysis was used to compare results across the three study groups. Results: A significant difference was found for the following tests among children with MASLD, obesity, and healthy controls: defensin 6 (14.4 ng/mL vs. 6.13 ng/mL vs. 17.2 ng/mL, respectively), L-FABP (9168 pg/mL vs. 7954 pg/mL vs. 7620 pg/mL, respectively), and I-FABP (272 pg/mL vs. 321 pg/mL vs. 330 pg/mL, respectively). No differences were found in defensin 5 levels (median 567.2 pg/mL vs. 485.7 pg/mL vs. 601.8 pg/mL). No differences were observed in cholesterol levels (HDL, LDL) or triglyceride concentrations, as well as apolipoprotein levels. Conclusions: Based on our study, it was concluded that inflammation and intestinal barrier damage lead to increased L-FABP levels, as it is released from enterocytes in response to oxidative stress or tissue damage. Defensin 6 may indirectly affect L-FABP through microbiota regulation and protection of the intestinal barrier. Defensin 6 also exerts antimicrobial activity and may accompany liver inflammation, with its increased concentration in comparison to obesity explained by the activation of defense mechanisms. Full article

(This article belongs to the Special Issue Clinical Advances in Metabolic Dysfunction-Associated Steatotic Liver Disease)

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11 pages, 1898 KB

Open AccessArticle

Impact of Education on Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Southern Italy Cohort-Based Study

by Rossella Donghia, Caterina Bonfiglio, Gianluigi Giannelli and Rossella Tatoli

J. Clin. Med. 2025, 14(6), 1950; https://doi.org/10.3390/jcm14061950 - 13 Mar 2025

Cited by 4 | Viewed by 1007

Abstract

Background: An association between education levels and liver disease has been confirmed, but not yet with metabolic dysfunction-associated steatotic liver disease (MASLD). The aim is to investigate the relationship between education and MASLD in two cohorts in southern Italy. Methods: The study cohort included 2909 participants assessed during the third recall of the MICOL study and the second of NUTRIHEP, subdivided into four groups based on education levels. Results: A strong protective association was found between MASLD and higher education levels. Participants had an OR = 0.50 (p < 0.001, 0.36 to 0.69 95% C.I.), OR = 0.29 (p < 0.001, 0.21 to 0.41), and OR = 0.24 (p < 0.001, 0.16 to 0.37 95% C.I.) for middle, high school, and graduate education, respectively. Conclusions: This study’s findings indicate that there is an association linking MASLD with education level, i.e., having a lower education level increases the risk of liver disease, and a proper policy to regulate education may also mitigate the ever-increasing problem of this disease. Full article

(This article belongs to the Special Issue Clinical Advances in Metabolic Dysfunction-Associated Steatotic Liver Disease)

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12 pages, 338 KB

Open AccessReview

Treatment Landscape of Metabolic-Dysfunction-Associated Steatotic Liver Disease

by Pranav Patel

J. Clin. Med. 2025, 14(17), 6060; https://doi.org/10.3390/jcm14176060 - 27 Aug 2025

Viewed by 1108

Abstract

Background/Objectives: The incidence of metabolic-dysfunction-associated steatotic liver disease (MASLD) is on the rise worldwide. The purpose of this paper is to review the current and emerging trends in the management and treatment of this condition. Methods: A comprehensive literature review was conducted using PubMed and GoogleScholar, focusing on articles published within the last ten years. Results: As the incidence of MASLD rises worldwide, it is becoming ever more important to call attention to disease prevention and progression. Although weight loss, diet, and exercise play a major role, certain therapies including GLP-1 receptor agonists, resmetirom, lanifibranor, and FGF-3 analogs are showing promise when treating patients with MASLD. As more drugs become available, it will be important to note how these medications change the global outlook of this disease. Conclusions: Overall, the treatment landscape of MASLD is rapidly changing. Several phase 3 trials have revealed promising data when it comes to improving liver fibrosis and histology. This shift in treatment will provide new hope for patients and clinicians when treating this challenging disease. Full article

(This article belongs to the Special Issue Clinical Advances in Metabolic Dysfunction-Associated Steatotic Liver Disease)

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