Will a “multivitamin” a day keep the “MASLD doctor” away?

This commentary discusses the results of a study that assessed the relationship between homocysteine metabolism and histological severity of metabolic dysfunction-associated steatotic liver disease (MASLD), and applied a mathematical model to examine how replacement with different cofactors (pyridoxine, cobalamin, betaine, and folate) may affect homocysteine levels in patients with MASLD. It highlights the clinical implications of the study and examines the pathophysiological support behind the detected associations. It also discusses its limitations, emphasizing the need for further longitudinal and interventional studies to confirm whether modulating homocysteine levels could be a viable therapeutic strategy for MASLD.