Volume 7, Issue 4

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most common chronic liver disease in South Asia, paralleling the region's rapid rise in type 2 diabetes and central obesity. South Asian adults develop hepatic steatosis, insulin resistance and diabetes at a lower body mass index than European populations, a pattern that reflects greater visceral and ectopic fat, early-life nutritional influences and genetic variants such as PNPLA3 I148M. As a result, many affected individuals are not obese by conventional criteria and may be missed by screening based on weight alone. This narrative review summarizes evidence on the epidemiology and risk phenotype of MASLD in South Asian populations, both in the region and in diaspora communities, and examines how the 2023 nomenclature, with its ethnicity-specific cardiometabolic criteria, applies to them. We discuss noninvasive fibrosis risk stratification with the FIB-4 index and vibration-controlled transient elastography, and the practical constraints of resource-variable health systems. Management centers on sustained weight loss through culturally adapted dietary change and physical activity, together with active treatment of diabetes, hypertension and dyslipidemia, since cardiovascular disease remains the leading cause of death. We review emerging pharmacotherapy, including resmetirom and glucagon-like peptide-1 receptor agonists, and note the limited representation of South Asian patients in pivotal trials. We conclude with priorities for practice: risk-based case finding in primary care and diabetes clinics, ethnicity-appropriate anthropometric thresholds and integrated cardiometabolic care.