Overlooked determinants and unequal outcomes: rethinking metabolic dysfunction-associated steatotic liver disease beyond the biomedical model

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a public health priority due to its high prevalence, silent clinical course, and liver and systemic outcomes. With an estimated prevalence of 30% in the general population, MASLD is the most common chronic liver disease worldwide. Apart from the underlying metabolic factors, MASLD development and progression are strongly influenced by social and commercial determinants of health, and an associated stigma, which perpetuate inequities and hinder access to high-quality clinical management. In this Personal View, we explore how social and commercial determinants of health shape environments that promote the development and progression of MASLD. We also examine how stigma acts as an underestimated barrier, contributing to diagnostic delays and impaired quality of life in people with MASLD. Based on an integrative perspective, we propose a comprehensive and multisectoral approach for the sustainable management of MASLD.