代谢功能障碍相关的脂肪肝病 (MASLD) 自 2023 年 6 月以来一直是非酒精性脂肪肝病 (NAFLD) 的术语，代表了全球最常见的肝脏疾病，也是肝脏相关发病率和死亡率的主要原因。由于 MASLD 是一种具有广泛临床表型的多方面疾病，因此需要对该疾病的自然史有全面的了解，以便及时对患者的风险进行分层。组织学疾病范围从孤立性肝脂肪变性（目前称为代谢功能障碍相关脂肪肝（MASL））到代谢功能障碍相关脂肪性肝炎（MASH），最终可能累积肝纤维化并发展为肝硬化和/或肝细胞癌（HCC）。纤维化进展的几个危险因素已被确定，而该疾病的进展显示出显着的动态性和双向性。与一般人群相比，所有 MASLD 组织学阶段均与较高的总体死亡率显着相关，并且这种关联表现出疾病严重程度依赖性模式。有趣的是，纤维化阶段是 MASLD 患者死亡率最准确的预测指标。 MASLD 导致的死亡率主要源于与肝脏和心血管系统以及 HCC 和肝外癌症相关的问题。鉴于疾病的自然病程，优先识别疾病进展的高危患者至关重要，以便有效解决和改变可改变的危险因素，从而减轻疾病并发症。需要进一步的研究来更准确地定义快速进展者的表型，并改善非肝硬化个体 HCC 的风险分层。版权所有 © 2023。由 Elsevier B.V. 出版。

Metabolic dysfunction-associated steatotic liver disease (MASLD), which has been the term for non-alcoholic fatty liver disease (NAFLD) since June 2023, represents the most common liver disease worldwide and is a leading cause of liver-related morbidity and mortality. A thorough knowledge of the disease's natural history is required to promptly stratify patients' risks, since MASLD is a multifaceted disorder with a broad range of clinical phenotypes. The histological disease spectrum ranges from isolated hepatic steatosis, currently named as metabolic dysfunction-associated steatotic liver (MASL), to metabolic dysfunction-associated steatohepatitis (MASH) and eventually may accumulate hepatic fibrosis and develop cirrhosis and/or hepatocellular carcinoma (HCC). Several risk factors for fibrosis progression have been identified, while the disease's progression displays notable dynamism and bidirectionality. When compared to the general population, all MASLD histological stages are substantially related with greater overall mortality, and this association exhibits a disease severity-dependent pattern. Interestingly, the fibrosis stage is the most accurate predictor of mortality among MASLD patients. The mortality attributed to MASLD predominantly stems from issues linked with the liver and cardiovascular system, as well as HCC and extrahepatic cancers. In light of the disease natural course, it is crucial to prioritize the identification of at-risk patients for disease progression in order to effectively address and change modifiable risk factors, hence mitigating disease complications. Further investigation is required to define the phenotype of rapid progressors more precisely as well as to improve risk stratification for HCC in non-cirrhotic individuals.Copyright © 2023. Published by Elsevier B.V.