From:  The transition from NAFLD to MASLD: implications for Diagnosis, Prognosis, and Clinical Management

 Multisystem complications associated with MASLD: organs involved, mechanisms, and clinical implications.

System/organMain complicationPathogenetic mechanismClinical impactReferences
CardiovascularEarly atherosclerosis, heart failureEndothelial dysfunction, chronic inflammation, lipotoxicityIncreased MACE, CV mortality[43, 46, 47, 52]
KidneyCKDInsulin resistance, systemic inflammation, vascular dysfunctionProgression to ESRD, worse outcomes[40, 41, 45, 56]
LiverHCC, iCCAAdvanced fibrosis, oxidative stress, epigenetic alterationsCancers even without cirrhosis[36, 37, 63]
Central nervous systemCognitive decline, dementiaSystemic inflammation, cerebral endothelial dysfunctionIncreased risk of cognitive impairment[65]
Immune systemSevere infectionsImmune dysregulation, chronic inflammatory stateHospitalizations, increased mortality[64]
Endocrine/metabolic systemPCOS, OSAS, sarcopeniaHormonal dysfunction, adiposopathy, inflammationWorsening of metabolic dysfunction[60–62]
Postmenopausal womenIncreased cardiovascular and MASLD riskLoss of estrogen protection, visceral obesityWorsened metabolic phenotype[66, 72, 73]
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CKD: chronic kidney disease; CV: cardiovascular; ESRD: end-stage renal disease; HCC: hepatocellular carcinoma; iCCA: intrahepatic cholangiocarcinoma; MACE: major adverse cardiovascular events; OSAS: obstructive sleep apnea syndrome; PCOS: polycystic ovary syndrome.