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left alone, it can progress to MASH, fibrosis, and cirrhosis. Tirzepatide trials in MASLD/MASH show meaningful drops in liver fat, liver enzymes, and inflammatory changes on biopsy, with higher rates of NASH/MASH resolution and fibrosis improvement compared with placebo. Semaglutide also improves MASLD and MASH: phase 2 and phase 3 work, plus large realworld cohorts, link it to better liver histology, less fibrosis progression, and improved survival in MASLD patients versus controls. Both drugs are legitimate liverprotection tools in metabolic disease

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