Is Liver Steatosis a Disease or the Emperor’s New Clothes?

The redefinition of steatotic liver disease, including metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH), has sharpened the distinction between benign hepatic fat accumulation and true liver pathology. MASLD has a global prevalence of 25-30%, but this should not be regarded as the prevalence of individuals with liver disease requiring diagnosis and treatment, as only a minority will progress to advanced disease with liver-related morbidity or mortality. Steatosis alone is often a phenotype or risk marker for liver disease or cardiometabolic disease – not a disease per se in the conventional sense.