Donghyun Ko, Jordan Low, Péter Lőw, Damien Chua, Yock Young Dan, Vincent Chen, Jonathan A. Fallowfield, Timothy J. Kendall, Hirokazu Takahashi, Cheng Han Ng, Nicholas Syn, Mark Muthiah
Metabolic dysfunction–associated steatotic liver disease (MASLD) encompasses a broad spectrum of biological and clinical variability driven by diverse genetic, metabolic, histologic, and environmental factors. In this narrative review, we synthesize current evidence on the multidimensional heterogeneity of MASLD and outline how these variations shape disease mechanisms, progression, and potential precision-medicine strategies. We integrate insights from genetic determinants with differences in histopathology, clinical phenotypes, gut microbiome signatures, and body composition to highlight how these factors may contribute to distinct disease trajectories and therapeutic responses.