Metabolic Dysfunction - Associated Steatotic Liver Disease (MASLD): An Integrative Perspective from Modern Hepatology and Ayurveda

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has emerged as a major global health concern, closely linked with obesity, insulin resistance, and metabolic syndrome. It represents a spectrum of liver disorders ranging from simple steatosis to steatohepatitis, fibrosis, and cirrhosis. Modern hepatology explains its pathogenesis through a multifactorial “multiple-hit” model involving lipid accumulation, oxidative stress, inflammation, and gut– liver axis dysfunction. Ayurveda offers a holistic perspective that parallels these mechanisms through the concepts of Agni (metabolic fire), Ama (metabolic toxins), and Medoroga (disorder of fat metabolism). The liver (Yakrit) is described as a central organ in blood and metabolic regulation, governed by Ranjaka Pitta. Impairment of Agni leads to Ama formation, Meda accumulation, and obstruction of bodily channels (Srotorodha), which closely resembles the metabolic and inflammatory processes seen in MASLD. This study integrates modern scientific evidence from PubMed, Scopus, and ScienceDirect with classical Ayurvedic principles to explore the pathophysiology, clinical features, diagnosis, complications, and management of MASLD. An integrative 5-step management model is discussed, focusing on lifestyle modification, metabolic correction, inflammation control, gut-liver axis modulation, and longterm maintenance. The findings suggest that an integrative approach combining Ayurveda and modern medicine provides a comprehensive framework for understanding and managing MASLD. Such an approach not only addresses disease progression but also targets its root metabolic causes, offering potential for effective prevention and reversal. Further clinical research is needed to validate these integrative strategies and establish their role in evidencebased practice.