Redefining liver health: a multidimensional approach to preventing metabolic dysfunction-associated steatohepatitis

Abstract

Metabolic dysfunction–associated steatohepatitis (MASH) is a rapidly escalating global health challenge driven by complex interactions among metabolic regulation, nutrition, immune signalling, gut microbiota, and environmental exposures. Current disease-centric frameworks prioritize late-stage pathology rather than early metabolic resilience. This article aims to redefine liver health as a dynamic, multidimensional state and to propose a prevention-oriented framework centered on nutrition and lifestyle as primary therapeutic pillars. This narrative review synthesizes current evidence on liver health and MASH. Relevant literature was identified through targeted searches, reference screening, and expert knowledge. The proposed framework positions liver health as an active state of metabolic flexibility supported by nutrition, physical activity, sleep quality, and circadian alignment. Advances in microbiome profiling, single-cell analyses, and multi-omics technologies reveal early disruptions that precede irreversible hepatic injury and may serve as actionable intervention targets. Nutrition emerges as a foundational driver that modulates systemic metabolism, inflammatory tone, and host–microbiome interactions. A multidimensional, nutrition-first strategy offers scalable opportunities for early screening, individualized prevention, and public health policy reform. Preventing MASH requires a paradigm shift from disease management to proactive cultivation of hepatic resilience. Integrating nutrition-centered, multidimensional interventions into clinical practice and policy can intercept disease trajectories before histological damage occurs.