Metabolic dysfunction-associated steatohepatitis is a leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation, with the burden rising rapidly in people with type 2 diabetes, prediabetes, and obesity. In this mini-review, we summarize recent data on prevalence and regional disparities, and discuss key mechanisms including insulin resistance, lipotoxic injury, organelle stress, immune activation, and fibrogenic signaling. We review advances in noninvasive diagnostics, with emphasis on stepwise strategies using FIB-4 and noninvasive tests such as elastography. Finally, we address cardiovascular risk and systemic inequities that continue to delay diagnosis and limit access to care.