What is MASLD and why are cases rising?
Global health experts are sounding the alarm over a sharp rise in fatty liver disease, now often referred to as MASLD (Metabolic dysfunction-associated steatotic liver disease). Recent estimates place the condition in roughly 38% of the adult population worldwide, representing a 15% increase compared with two decades ago. MASLD has become the most common chronic liver disease and can progress from fatty accumulation in hepatocytes to inflammation, fibrosis, cirrhosis, and even liver cancer if left unchecked.
In Italy, as discussed at the XVII Cleo national congress in Foggia, estimates suggest that a substantial portion of adults live with some degree of fatty liver, frequently linked to metabolic dysfunctions such as obesity, type 2 diabetes, high blood pressure, and abnormal lipids. The international term Mash, or metabolic-associated steatohepatitis, refers to the inflammatory form that can accelerate progression to cirrhosis and tumor development. This evolving landscape has positioned hepatology at the forefront of public health and innovation, especially with AI entering routine care pathways.
Key tests and checks to diagnose MASLD
MASLD is often silent, which makes proactive screening essential, particularly for high-risk groups like diabetics and the obese. Diagnosis begins with a metabolic and liver panel. Clinicians review liver enzymes (transaminases) and cholestasis markers such as GGT and alkaline phosphatase, along with metabolic metrics—glucose, total cholesterol, triglycerides, LDL, and HDL. Abdominal ultrasound remains a cornerstone imaging test to detect fat deposition in the liver and to help stage the disease over time.
When MASLD progresses toward Mash, inflammatory activity and fibrosis come into play, altering prognosis and treatment choices. In many centers, a biopsy may be used to quantify inflammation and fibrosis; however, noninvasive imaging and blood-based scores are increasingly preferred to minimize risk and improve longitudinal monitoring. A careful, multidisciplinary approach is essential to identify at-risk patients early and tailor follow-up accordingly.
New therapies and lifestyle interventions
Treatment for Mash and MASLD continues to evolve. A novel drug class targeting the thyroid hormone receptor beta shows promise as a selective agonist that reduces hepatic fat, dampens inflammation, and lessens fibrotic progression, with favorable effects on LDL cholesterol and triglycerides. While pharmacologic advances add a valuable toolset, lifestyle remains foundational. Experts emphasize a healthy, balanced diet—preferably Mediterranean in style—and regular physical activity. Even 30 minutes of brisk walking daily can yield meaningful benefits in liver fat reduction and overall metabolic health.
The transformative role of AI in hepatology
The convergence of hepatology and artificial intelligence is reshaping how we diagnose, monitor, and personalize treatment for MASLD. AI-powered imaging analysis—applied to MRI, CT, and ultrasound—helps clinicians detect subtle abnormalities and pattern deviations that may escape the human eye, enabling earlier diagnoses and more accurate staging. Beyond imaging, AI integrates patient history, genetics, and treatment responses to propose tailored therapeutic strategies and improve adherence to regimens.
This year marks a milestone with the EMA approving an AI-based tool to analyze liver biopsy samples. Trained on tens of thousands of annotations and hundreds of biopsies, the software demonstrates reliable inflammation and fibrosis assessment with reduced interobserver variability. In Italy, the Ita-MASLD national study, coordinated by the Istituto Superiore di Sanità with Cleo participation, aims to collect real-world evidence prospectively to guide practice and policy as these technologies mature.
Towards a data-driven future for liver health
As MASLD becomes a leading public health challenge, the integration of AI with traditional clinical practice offers unprecedented opportunities to detect disease early, customize care, and improve outcomes. The dialogue between clinicians, researchers, and technology developers will be essential to ensure these tools augment, rather than replace, clinical judgment and patient-centered care.
Bottom line
Rising fatty liver disease calls for comprehensive screening in at‑risk populations, careful interpretation of labs and imaging, timely lifestyle interventions, and the judicious use of new therapies. AI is accelerating diagnostic accuracy and enabling personalized management, but it must complement the core principle of medicine: patient care tailored to individual needs.
