Histologic Features and Clinical Outcomes of Lean Metabolic Dysfunction-Associated Steatotic Liver Disease.

Lean MASLD exhibits milder histologic features but similar clinical outcomes compared to overweight/obese MASLD, with 6.7% of patients being lean globally.

• Why it matters: Understanding the characteristics of lean MASLD is crucial because it challenges the traditional association of fatty liver disease solely with obesity and may influence diagnosis and management strategies.
• What they did: The study analyzed 18,326 adults with biopsy-confirmed MASLD from 41 countries, comparing clinical, histologic, and prognostic features between lean and overweight/obese groups, including noninvasive fibrosis tests.
• The result: Lean MASLD was linked to less severe fibrosis and metabolic comorbidities, with fibrosis severity, not body composition, predicting outcomes; liver stiffness measurement proved reliable regardless of weight status.