Metabolic dysfunction-associated steatotic liver disease in prison populations: a review of its impact and current and future challenges.

Objectives: Review the epidemiology of metabolic dysfunction-associated steatotic liver disease (MASLD), and the main diagnostic and therapeutic challenges, with a specific focus on its management in the prison population. Material and method: MASLD is the most prevalent form of chronic liver disease worldwide and represents an increasing challenge for public health and healthcare systems. Prison inmates are particularly vulnerable to this condition due to a combination of individual and social factors and to characteristics within the correctional system itself. These vulnerabilities have contributed to an epidemiological transition, whereby metabolic comorbidities have replaced transmittable diseases as the main cause of morbimortality. Conclusions: The growing burden of metabolic disease in correctional settings underscores the urgent need for effective screening and referral strategies for early MASLD detection. However, current protocols remain poorly defined, and there is limited evidence regarding their cost-effectiveness in this specific context. These gaps highlight the pressing need for further research and the development of public health policies tailored to the unique characteristics of this high-risk population.