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Rates of metabolic dysfunction-associated steatotic liver disease (MASLD) continue to rise worldwide, prompting growing interest in when risk for metabolic liver disease actually begins. While clinical care often focuses on patients once metabolic dysfunction is already established, emerging research suggests the roots of MASLD may develop much earlier in life. In this interview, Stefani Tica, MD, MPH, discusses new research examining how parental health and early-life factors may influence the development of MASLD later in life. The study takes a population health and life-course approach, exploring how risk may accumulate long before patients present in the clinic. Tica explains how complex interactions between genetics, environment, lifestyle, and metabolic health contribute to MASLD risk, and why focusing only on a patient’s current body mass index or metabolic markers may overlook important earlier drivers of disease. The research also examines the role of cumulative childhood adiposity, analyzing how both the duration and intensity of excess adiposity between ages 7 and 17 may influence future MASLD risk. The findings highlight the potential importance of earlier interventions and family-centered approaches to metabolic health, particularly in pediatric populations. Tica also discusses the unanswered questions raised by this research, including the possible roles of epigenetics and changes in the gut microbiome, as well as the need for further mechanistic studies to better understand how these risks develop—and whether they can be modified. Full article: https://www.hcplive.com/view/understa...