Understanding the Surge in MASLD
Fatty liver disease is increasingly common worldwide, with MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) emerging as the predominant form. Global estimates place the prevalence around 38% among adults, with a notable 15% increase over the last two decades. MASLD often coexists with metabolic disorders such as obesity, type 2 diabetes, hypertension, and dyslipidemia, forming a cluster that raises the risk of liver inflammation, fibrosis, and, in advanced stages, cirrhosis or liver cancer. The topic gained prominence at the XVII National Congress of the Club Epato l ogi Ospedalieri (Cleo) in Foggia, under the banner “Hepatology in the AI Era: Insights and Reflections.”
What MASLD Is and Why It Matters
MASLD is the non-alcoholic spectrum of fatty liver disease driven by metabolic dysfunction. When fat accumulation becomes inflammatory, the condition is termed Mash (Metabolic-Associated Steatohepatitis). Mash can progress to fibrosis and cirrhosis, increasing the risk of hepatocellular carcinoma. As the disease affects a large portion of the adult population, early recognition and personalized management are essential to prevent long-term complications.
Key Exams and Follow-Up for Diagnosis
Diagnosing MASLD is often challenging because it is frequently silent. A comprehensive assessment combines laboratory tests, imaging, and clinical risk factors. Typical steps include:
- Blood tests to evaluate liver enzymes (transaminases) and cholestasis markers, plus metabolic panels (glucose, total cholesterol, triglycerides, LDL, HDL).
- Ultrasound imaging to detect hepatic steatosis, often complemented by elastography or other non-invasive tests to assess fibrosis.
- Risk stratification for individuals with obesity, diabetes, or metabolic syndrome to determine intensity of follow-up and lifestyle interventions.
Early identification is crucial because undiagnosed MASLD in high-risk groups may foster inflammatory states and liver injury, potentially advancing to Mash and, ultimately, cirrhosis.
Mash and the Potential for Progression
The Mash phase represents the inflammatory and fibrotic evolution of fatty liver disease. It is the critical point at which progressive liver damage becomes more likely, influencing prognosis and treatment choices. Contemporary management aims to reduce liver fat, quell inflammation, and slow fibrotic progression, in addition to addressing coexisting metabolic conditions.
New Treatments and Therapeutic Avenues
Advances in pharmacotherapy are expanding options for reducing liver fat and improving liver health. A notable development is a selective beta-TH receptor agonist that targets hepatic fat and inflammation, with favorable effects on cholesterol and triglycerides. While not a universal cure, such therapies can complement lifestyle strategies in patients at higher risk of Mash and cirrhosis.
The Role of AI in Personalised Medicine
Artificial intelligence is increasingly embedded in hepatology, enhancing diagnostic accuracy and individualizing care. In imaging, AI-powered analysis of MRI, CT, and ultrasound can detect subtle patterns that may be missed by the human eye, enabling faster and more precise diagnoses. Beyond imaging, AI can integrate patient history, genetics, and prior treatment responses to tailor therapy plans and support better adherence to treatment regimens.
AI in Diagnostics and Imaging
Computer-assisted imaging helps clinicians distinguish MASLD from other liver conditions and assess disease severity with greater confidence. This technology accelerates decision-making and may reduce unnecessary invasive procedures.
AI-Guided Biopsy Analysis and Regulatory Milestones
This year, the European Medicines Agency (EMA) sanctioned an AI-based tool for analyzing liver biopsies. Trained on thousands of biopsy samples and characterized by high reliability in assessing inflammation and fibrosis, the tool reduces diagnostic variability among pathologists. In Italy, the Ita-MASLD study—led by the Istituto Superiore di Sanità with Cleo participation—will collect real-world, prospective evidence to refine practice guidelines and accelerate the integration of AI into routine care.
Lifestyle, Prevention, and the Italian Effort
Prevention remains grounded in lifestyle. A balanced diet, dominated by Mediterranean principles—rich in fruits, vegetables, whole grains, healthy fats, and lean proteins—paired with regular physical activity, can markedly reduce MASLD risk. Practical targets include at least 30 minutes of brisk walking most days and attention to weight management, glucose control, and lipid levels.
The Cleo congress underscored that technology, when paired with “natural intelligence,” can transform early detection and personalized treatment, improving outcomes for millions at risk of MASLD worldwide.
Conclusion
The rise of MASLD calls for proactive screening of at-risk populations, non-invasive diagnostics, and AI-enabled personalized care. With ongoing research, new therapeutic avenues, and national initiatives like Ita-MASLD, the medical community is better equipped to curb the progression of fatty liver disease and safeguard liver health on a global scale.
