Eligibility Criteria:
Inclusion Criteria:
* Fully understand this study and voluntarily sign the informed consent form; willing to comply with and capable of completing all trial procedures.
* Meet the diagnostic criteria for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).
* Age ≥18 and ≤60 years, regardless of gender.
Exclusion Criteria:
* Patients with other diseases that may secondarily cause fatty liver disease, including hepatitis B or C virus infection, α-1 antitrypsin deficiency, Wilson's disease, hemochromatosis, autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, or HIV infection.
* Alcohol consumption ≥140 g/week for females or ≥210 g/week for males.
* Patients with current or history of cirrhosis or any prior event of hepatic decompensation (i.e., ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, esophageal varices, and/or hepatorenal syndrome).
(4) Patients with abnormal vital signs, complete blood count (CBC), renal function, or thyroid function (Alanine Aminotransferase \[ALT\] \>5× upper limit of normal \[ULN\]; Creatinine \[Cr\] \>ULN; Albumin \[ALB\] \<3.5 g/L; TSH \>2× ULN; electrolyte imbalances).
* Patients with severe cardiovascular or cerebrovascular diseases (including uncontrolled hypertension, defined as systolic blood pressure \>170 mmHg or diastolic blood pressure \>100 mmHg), renal diseases, hematopoietic system diseases, psychiatric disorders, autoimmune diseases, or active cancer.
* Glycated Hemoglobin A1c (HbA1c) \>7% (in patients without prior history of diabetes).
* Patients with inflammatory bowel disease, intestinal obstruction or pseudo-obstruction, chronic diarrhea, or unexplained abdominal pain.
* Use of medications related to MASLD within 3 months prior to the study (e.g., metformin, thiazolidinediones, dipeptidyl peptidase-4 inhibitors \[DPP-4i\], glucagon-like peptide-1 receptor agonists \[GLP-1RA\], sodium-glucose cotransporter-2 inhibitors \[SGLT-2i\], S-adenosylmethionine \[SAM-e\], polyenphosphatidylcholine, glycyrrhizin, bicyclol, reduced glutathione, betaine, fish oil, silymarin, obeticholic acid/ursodeoxycholic acid \[OCA/UDCA\], phosphodiesterase inhibitors \[PDEi\], gemfibrozil, vitamin E, long-term antibiotics \[\>1 week\], THR-β agonists \[resmetirom\], initiation or adjustment of lipid-lowering regimens, corticosteroids, immunosuppressants, or Chinese herbal extracts for MASLD treatment \[e.g., hawthorn, cassia seed, salvia, notoginseng, kudzu, alisma\], or herbal teas \[e.g., Ilex chingiana, Kuding tea, Gynostemma, lotus leaf, Pu-erh tea\]). Exclusion applies if any of the above criteria are met.
* History of bariatric surgery within the past 2 years.
* History of allergy to diacerein or anthraquinone derivatives.
* Use of diacerein within the past 3 months.
* Pregnant or lactating women, or those planning pregnancy within the next 6 months.
* Participation in another clinical trial involving investigational drugs or devices.
* Contraindications to conventional MRI (e.g., metal implants).
* Inability to complete the study or comply with its requirements, as determined by the investigator.
* Weight gain or loss \>5% within 6 months prior to baseline, or \>10% within 12 months prior to screening.
* CAP value ≥248 dB/m on Fibroscan but MRI-PDFF \<5%.