Egypt’s metabolic dysfunction associated steatotic liver disease: Genetic and dietary nexus, shaping artificial intelligence driven healthier future

BACKGROUND Metabolically dysfunction-associated steatotic liver disease (MASLD) has emerged as a significant global health concern; however, its burden and determinants in Egypt remain poorly characterized. AIM To determine the prevalence of MASLD, identify risk factors, and evaluate genetic influences in the Egyptian population. METHODS In this multicenter observational cross-sectional study (2019-2024), 1060 adults from 22 governorates underwent a comprehensive assessment, including anthropometrics, metabolic profiling, dietary evaluation (validated Food Frequency Questionnaire), abdominal ultrasonography, vibration-controlled transient elastography (FibroScan®), and PNPLA3 rs738409 genotyping. MASLD was diagnosed according to the European Association for the Study of the Liver 2024 guidelines. RESULTS An alarmingly high prevalence of MASLD (67.7%) was revealed. Obesity conferring a 27.5-fold increased risk (P < 0.001), insulin resistance was associated with a 3.4-fold higher risk, metabolic syndrome present in 41.2% of cases. Each 1-gram increase in monounsaturated fatty acid and polyunsaturated fatty acid intake raised the risk by 3% and 10%, respectively. High glycemic load increased the risk by 1% per unit. PNPLA3 gene variant present in 48.1% of MASLD cases compared to 43.6% of healthy individuals. Variant carriers exhibited distinct risk profiles related to age and polyunsaturated fatty acid intake. Demographic patterns were notable, as prevalence increased from 52% in individuals < 38 years to 83% in those ≥ 38 years, while lean individuals still demonstrated a prevalence of 22.2%. CONCLUSION Egypt faces an epidemic of MASLD reflecting complex interactions among metabolic, dietary and genetic factors. Implementation of national screening programs and culturally tailored lifestyle interventions is urgently needed.