Association of obesity with liver fibrosis in patients with metabolic dysfunction–associated fatty liver disease: A review of current evidence

Resume. Metabolic Dysfunction–Associated Fatty Liver Disease (MAFLD), recently incorporated within the broader concept of Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD), has become one of the most prevalent chronic liver diseases worldwide. The growing prevalence of obesity, type 2 diabetes mellitus, insulin resistance, and metabolic syndrome has contributed substantially to the increasing burden of MAFLD. Among the histological features of the disease, liver fibrosis represents the most important predictor of long-term clinical outcomes, including cirrhosis, liver failure, hepatocellular carcinoma, and liver-related mortality. Although obesity is recognized as a major risk factor for the development and progression of MAFLD, accumulating evidence indicates that significant fibrosis may also occur in non-obese individuals, suggesting that factors beyond body mass index contribute to disease progression. The present review summarizes current evidence regarding the association between obesity and liver fibrosis in patients with MAFLD. Particular attention is given to the epidemiology of the disease, mechanisms linking obesity with hepatic fibrogenesis, the role of insulin resistance and chronic inflammation, clinical assessment of fibrosis, and emerging therapeutic strategies. Recent studies demonstrate that obesity accelerates fibrosis progression through adipose tissue dysfunction, oxidative stress, cytokine-mediated inflammation, and activation of hepatic stellate cells. However, non-obese MAFLD patients may also develop advanced fibrosis due to genetic predisposition, visceral adiposity, and metabolic abnormalities. Current non-invasive diagnostic approaches including elastography, fibrosis scores, and imaging biomarkers have improved the identification of high-risk patients. Early recognition of fibrosis and comprehensive management of metabolic risk factors remain essential for preventing disease progression and improving clinical outcomes. Keywords: MAFLD, MASLD, obesity, liver fibrosis, steatosis, metabolic syndrome, elastography, inflammation.