Minireviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. May 24, 2024; 15(2): 92791
Published online May 24, 2024. doi: 10.4291/wjgp.v15.i2.92791
Metabolic dysfunction-associated steatotic liver disease heterogeneity: Need of subtyping
Shahid Habib
Shahid Habib, Department of Hepatology, Liver Institute PLLC, Tucson, AZ 85716, United States
Author contributions: Habib S hypothesis genesis, data collection, critical data review and synthesis, manuscript writing and submission.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shahid Habib, MD, Doctor, Researcher, Department of Hepatology, Liver Institute PLLC, 3232 E Speedway Bvd, Tucson, AZ 85716, United States. shabib@liverinstitutepllc.org
Received: February 5, 2024
Revised: April 4, 2024
Accepted: April 24, 2024
Published online: May 24, 2024
Processing time: 107 Days and 14.4 Hours
Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a widespread global disease with significant health burden. Unhealthy lifestyle, obesity, diabetes mellitus (DM), insulin resistance, and genetics have been implicated in the pathogenesis of MASLD. A significant degree of heterogeneity exists among each of above-mentioned risk factors. Heterogeneity of these risk factors translates into the heterogeneity of MASLD. On the other hand, MASLD can itself lead to insulin resistance and DM. Such heterogeneity makes it difficult to assess the natural course of an individual with MASLD in clinical practice. At present MASLD is considered as one disease despite the variability of etiopathogenic processes, and we lack the consensus definitions of unique subtypes of MASLD. In this review, pathogenic processes of MASLD are discussed and a need of subtyping is recommended.

Keywords: Metabolic dysfunctions-associated steatotic liver disease; Visceral obesity; Genetics; Diabetes; Insulin resistance

Core Tip: Metabolic dysfunctions-associated steatotic liver disease (MASLD) is a pathogenically heterogeneous disease with dynamic pathological features. The cardiometabolic risk of MASLD varies based on underlying etiopathogenic processes. Four subtypes of MASLD have been identified: Diabetic, non-diabetic (insulin resistance), genetic and mixed. These subtypes have not been clearly defined yet as separate entities. Given such heterogeneity, the behavior and outcome of MASLD in each patient is expected to be different. Therefore, a single drug is not expected to work for all patients with MASLD. The natural history of MASLD subtypes is unknown. There is an unmet need to categorize its subtypes and prospective studies are needed to characterize each subtype.