Inclusion criteria:
Diagnosis of MASLD/NAFLD based on clinical, laboratory, and imaging criteria by a gastroenterologist/hepatologist.
Grade 2 or 3 hepatic steatosis on baseline B-mode ultrasonography.
Age 18 years or older.
Clinically stable condition without acute hepatitis, acute liver failure, or current hospitalization for an acute liver condition.
Stable main disease-related treatments without major changes during the previous 4 to 6 weeks, according to the treating physician.
Ability to attend all scheduled study visits and follow-up assessments and, if allocated to the intervention group, the acupuncture sessions.
Willingness to participate and provision of written informed consent.
Exclusion criteria:
Grade 0 or 1 hepatic steatosis on baseline ultrasonography according to the protocol-defined criteria, because only participants with grade 2 or 3 steatosis are eligible for this study.
Evidence of cirrhosis, advanced hepatic fibrosis, liver failure, or hepatic decompensation.
Other causes of liver disease, including active viral hepatitis, autoimmune hepatitis, biliary disease, Wilson disease, or hemochromatosis.
Significant alcohol consumption exceeding 20 g/day in women or 30 g/day in men.
Use of potent anticoagulants such as warfarin or direct oral anticoagulants, or severe coagulopathy making acupuncture unsafe.
Severe thrombocytopenia or another bleeding disorder preventing safe needling.
History of severe hypersensitivity or marked intolerance to needling, or extensive skin lesions at the intended acupuncture sites.
Pregnancy or breastfeeding.
Advanced malignancy or an incurable systemic disease with a life expectancy of less than 6 months.
Regular acupuncture treatment for a related condition during the previous 3 months.