Diagnosis and monitoring of metabolic dysfunction-associated steatohepatitis disease: a critical review.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide and includes a spectrum ranging from simple steatosis to metabolic dysfunction-associated steatohepatitis (MASH), advanced fibrosis, and cirrhosis. Given the heterogeneous nature of disease progression and the central role of fibrosis predicting local or systemic clinical outcomes (e.g. liver cirrhosis, hepatocarcinoma, cardiovascular diseases), early identification and longitudinal monitoring of individuals at risk is crucial. However, current diagnostic tools present important limitations, particularly across diverse metabolic profiles such as individuals living with obesity or type 2 diabetes. Therefore, this review provides a comprehensive overview of current diagnostic and monitoring strategies for MASLD and MASH, including routine biochemical markers, noninvasive steatosis and fibrosis scores, imaging modalities, and liver biopsy. Multimodal and individualized diagnostic approaches integrating clinical, metabolic, imaging, and molecular data appear essential to improve early detection, refine longitudinal monitoring, and support precision-based management of MASLD.