Highlight
• Weight gain greater than 5% in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is significantly associated with increased risk of liver-related events (LREs) and progression of liver stiffness.
• Weight loss exceeding 5% correlates with liver stiffness improvement and may decrease LRE risk, particularly in patients achieving obesity reversal.
• Transitioning into or persisting with obesity heightens LRE risks, whereas reverting from obesity to non-obesity aligns risk similarly to persistent non-obese individuals.
• Adjusted analyses accounted for critical confounders including baseline BMI, diabetes, hypertension, liver stiffness measurement (LSM), steatosis assessment (CAP), and specific antidiabetic therapies (SGLT-2 inhibitors, GLP-1 receptor agonists).
