Diagnosis and Management of Lean Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Systematic Review

Abstract

Background Lean Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) challenges traditional perceptions of fatty liver diseases, occurring in non-obese individuals. The shift in nomenclature from non-alcoholic fatty liver disease to metabolic dysfunction-associated steatotic liver disease reflects a broader understanding of its pathophysiology, emphasizing the intricate interplay of metabolic components beyond obesity. Despite its clinical relevance, the diagnosis and management of Lean MASLD pose unique challenges due to historical associations with obesity and limited awareness of its distinctive features.

Methods A comprehensive systematic literature search was conducted on December 4th, 2023, in six databases using specific criteria. Only peer-reviewed studies in the English language, focusing on either diagnosis or management of lean MASLD. were included. This study is registered with PROSPERO (CRD42023489308)

Results Following PRISMA guidelines, a total of 95 studies were included, with 43 studies focusing on diagnosis and surveillance of MASLD, while 52 studies focused on management of MASLD. The findings provide insights into the challenges associated with diagnosing Lean MASLD. Emphasis is placed on the evolving diagnostic criteria, acknowledging the limitations of traditional markers and exploring advanced imaging modalities. Management strategies are explored, including lifestyle interventions and potential pharmacological treatments, considering the unique metabolic characteristics of this patient population.

Conclusion The findings underscore the need for heightened clinical awareness, regular monitoring, and tailored therapeutic approaches in lean MASLD. Further research is essential to refine diagnostic criteria and develop targeted treatments, paving the way for improved care for individuals with Lean MASLD.