Once considered a harmless finding, fatty liver disease is now recognised as one of the world’s most common chronic liver conditions and a major driver of metabolic disease. Now officially termed MASLD (metabolic dysfunction-associated steatotic liver disease), it affects nearly 1 in 3 adults globally and is strongly linked to obesity, insulin resistance, type 2 diabetes, and metabolic syndrome. Often silent in its early stages, MASLD can progress from simple fat accumulation to inflammation (MASH), fibrosis, cirrhosis, and even liver cancer if left unmanaged. Current evidence shows that lifestyle changes — especially weight loss, exercise, and a Mediterranean-style diet — remain the most effective treatment, while newer medications such as resmetirom and GLP-1 therapies are transforming care for advanced disease.