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Pathophysiologically, MASLD is strongly associated with insulin resistance, leading to hepatic lipid accumulation, inflammation, and in advanced stages, fibrosis and cirrhosis

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A phase 2 randomised controlled trial published in the New England Journal of Medicine (2023) reported substantial weight loss and improvements in glycaemic parameters, though the trial was conducted in a closely monitored clinical setting with defined eligibility criteria

Spermidine-mediated induction of autophagy requires that the pro-autophagic transcription factor identified as TFEB (transcription factor EB, where the EB refers to enhancer box binding site) be activated

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