Rising fatty liver cases: what MasLD means for health
Recent expert discussions highlight a worrying rise in fatty liver disease. Known as Metabolic dysfunction-associated steatotic liver disease (MasLD), this condition now affects a large share of adults worldwide and is increasingly recognized as a major public health challenge. MasLD describes the abnormal buildup of fat within liver cells and, if unchecked, can progress to liver inflammation, fibrosis, cirrhosis, and even liver cancer. The trend has been a focal point at the XVII Cleo national congress in Foggia, which explored how artificial intelligence is shaping hepatology today and tomorrow.
In Europe and beyond, estimates suggest a substantial portion of adults harbor some degree of fatty liver, with MasLD identified as the non-alcoholic form linked to metabolic dysfunction. Clinicians note that obesity, type 2 diabetes, hypertension, and dyslipidemia commonly accompany MasLD, underscoring the intertwining of liver health with overall metabolic status. While the disease is more often silent, its long-term consequences can be severe if not detected and managed early.
What exams and checks diagnose fatty liver
Diagnosis relies on a combination of laboratory tests and imaging. Initial screening typically includes liver enzyme levels—transaminases (ALT and AST)—and cholestasis markers such as gamma-glutamyl transferase (GGT) and alkaline phosphatase. A full metabolic panel is also informative and looks at fasting glucose, total cholesterol, triglycerides, LDL, and HDL cholesterol. An abdominal ultrasound is a key imaging test to assess the presence and extent of fat accumulation in the liver and to monitor changes over time.
For patients at higher risk—such as those with obesity or diabetes—the evaluation often goes beyond a single test. The international working definition now centers on MasLD as the liver condition associated with metabolic dysfunction, with a progression stage called metabolic dysfunction-associated steatohepatitis (MASH) that can advance to fibrotic liver disease. Early recognition through a systematic approach to testing helps identify individuals who may benefit from lifestyle, pharmacologic, or other therapeutic interventions.
New therapies and the role of lifestyle in prevention
Emerging treatments are expanding options beyond lifestyle change. A selective thyroid hormone receptor beta (THR‑β) agonist is being studied for MasLD/MASH, showing promise in reducing liver fat, dampening inflammation, and decreasing fibrosis, while also improving lipid profiles. While not a universal cure, such therapies illustrate the potential to alter the disease trajectory when combined with diet and exercise guidelines.
Lifestyle remains the foundation of prevention and management. A healthy, balanced diet—especially one aligned with the Mediterranean pattern—along with regular physical activity can significantly impact liver fat and overall metabolic health. Clinicians commonly recommend at least 30 minutes of brisk walking most days and avoiding ultra-processed foods, excessive sugars, and saturated fats to support liver health over the long term.
AI in imaging and pathology: a new era for personal medicine
The event showcased how artificial intelligence supports personalized care. In medical imaging, AI systems analyze magnetic resonance imaging (MRI), CT, and ultrasound to detect subtle patterns of fat, inflammation, and fibrosis more consistently and quickly than traditional assessment alone. In pathology, AI-enabled biopsy analysis is advancing diagnostic precision and reducing inter-observer variability. This year, the European Medicines Agency (EMA) approved an AI tool designed to analyze liver biopsy samples, trained on tens of thousands of annotations and thousands of biopsies from multiple trials. The goal is to deliver more reliable staging of inflammation and fibrosis, complementing the pathologist’s expertise.
Italy is launching the Ita-MasLD study, coordinated by the Institute of Health (ISS) with participation from Cleo, to collect real-world data across diverse settings. These efforts aim to refine diagnostic algorithms, optimize treatment pathways, and support evidence-based decisions for patients in everyday clinical practice.
Looking ahead: a balanced, data-driven approach
Experts emphasize that technology must serve patients and clinicians, not replace clinical judgment. AI can shorten the time to diagnosis, tailor therapies to individual risk profiles, and improve treatment adherence through better monitoring. Yet human oversight remains essential—interpreting results in the context of a patient’s history, genetics, and lifestyle choices is irreplaceable. The Cleo congress reinforced that the fusion of intelligent tools with compassionate, individualized care can change the natural history of MasLD and related liver diseases, translating research into tangible public health gains.
