Precision Medicine in Metabolic Dysfunction-Associated Steatotic Liver Disease: Advances in Diagnosis, Risk Stratification, and Personalized Management

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has emerged as one of the most prevalent chronic liver diseases worldwide and represents a growing challenge for healthcare systems due to its close relationship with obesity, insulin resistance, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome. This review aimed to integrate current scientific evidence regarding the epidemiology, pathophysiology, clinical progression, diagnosis, treatment, and emerging role of precision medicine in MASLD. International scientific literature was reviewed through recognized biomedical databases, incorporating original studies, systematic reviews, meta-analyses, clinical practice guidelines, and international consensus statements relevant to the disease. The evidence demonstrates a substantial global burden of MASLD, with particularly high prevalence estimates reported in Latin America and other regions experiencing rapid growth in cardiometabolic disorders. Disease progression is heterogeneous, ranging from hepatic steatosis to metabolic dysfunction-associated steatohepatitis, advanced fibrosis, cirrhosis, and hepatocellular carcinoma, with fibrosis representing one of the most important predictors of adverse clinical outcomes. Advances in non-invasive biomarkers, serum-based fibrosis scores, transient elastography, and magnetic resonance-based techniques have improved risk stratification and reduced dependence on liver biopsy. Lifestyle modification remains fundamental to treatment, while emerging pharmacological therapies provide additional opportunities for patients with specific metabolic and hepatic profiles. The integration of clinical characteristics, metabolic phenotype, fibrosis stage, imaging findings, and biological markers supports the transition toward precision medicine. MASLD should therefore be approached as a multisystem metabolic disease requiring early identification, multidisciplinary management, comprehensive cardiometabolic control, and individualized therapeutic strategies to reduce progression and long-term complications.