Fatty liver disease (FLD) is a rising public health concern, both in India and around the globe. In FLD, liver stores a large amount of fat which if untreated eventually leads to severe hepatic steatosis and irreversible liver damage (cirrhosis). Based on its underlying cause, it is mainly of two types: alcoholic fatty liver disease (AFLD) and metabolic dysfunction associated steatotic liver disease (MASLD). Extensive research has been conducted on the pathogenesis of MASLD but the underlying mechanisms are still not clear and misinterpreted. This review explores the pathways that trigger fatty liver disease and the severity of MASLD along with the comprehensive analysis of the drug treatments which are in practice or under study. A detailed assessment has been done on plant derived active chemical components as well. Current medications are mostly designed to address insulin resistance, inflammation, and oxidative stress; however, they are susceptible to adverse drug reactions. In addition, a significant amount of research has been conducted on the hepatoprotective effects of a variety of herbal compounds, which are known for their lipid-lowering, antioxidant, and anti-inflammatory properties, alongside maintaining minimal toxicity. Therefore, integrating conventional therapies with plant-based bioactive compounds may offer an additional effective and safer approach for the prevention and management of MASLD.

KEYWORDS: Fatty Liver, Hepatic Steatosis, Therapeutic Drugs, Chemical, Herbal, Hepatoprotective.