Diabetes and metabolic dysfunction-associated steatotic liver disease, CVD: a continuum

Non-alcoholic fatty liver disease (NAFLD) has emerged as the predominant chronic liver condition worldwide, affecting an estimated 38% of the global adult population [1].Regional prevalence varies significantly, with lower rates observed in Africa (13.5%) and higher rates in regions such as Mexico, Central and South America, the Middle East, and South Asia, where prevalence exceeds 30% [2,3].However, these figures may underestimate the true scope of the disease.Underdiagnosis of NAFLD remains a significant barrier to effective medical management, complicating efforts to gauge disease prevalence and associated complications.Factors contributing to underdiagnosis include limited awareness among both patients and healthcare providers, the typically asymptomatic nature of NAFLD in its early stages, and the lack of standardized diagnostic tools.Although plasma aminotransferase levels and liver ultrasonography are commonly used screening methods, their sensitivity in diagnosing and monitoring NAFLD is limited.In 2023, three major international liver associations proposed replacing the term NAFLD with metabolic dysfunction-associated steatotic liver disease (MASLD), and non-alcoholic steatohepatitis (NASH) with metabolic dysfunction-associated steatohepatitis (MASH).Current epidemiological data suggest a high concordance rate between NAFLD and MASLD definitions, with approximately 99% overlap [4].MASLD is a multisystem disorder in which systemic insulin resistance and related metabolic dysfunctions contribute to its development and associated liver-related morbidities (cirrhosis, liver failure, hepatocellular carcinoma) and extrahepatic complications, including cardiovascular disease (CVD), type 2 diabetes mellitus, chronic kidney