Silent Threat: The Rising Epidemic of Metabolic Dysfunction-Associated Liver disease (MASLD)
A growing global health crisis is unfolding, largely unnoticed: Metabolic Dysfunction-Associated Liver Disease (MASLD). Affecting an estimated 38% of adults worldwide, it’s now the most prevalent chronic liver condition, with its rise directly linked to increasing rates of obesity, type 2 diabetes, and metabolic syndrome. In Italy, the prevalence is notably concerning, impacting roughly one in five adults – a figure that climbs above 60% among individuals with diabetes.
This emerging understanding of MASLD is detailed in a recent thorough review published in the New England Journal of Medicine, authored by Luca Valenti, head of the Biological Resources Centre at the Policlinico di Milano and professor at the University of Milan, alongside two international experts. the review thoroughly examines the disease, from its underlying mechanisms to the latest therapeutic advancements.
A Disease Often Without warning
MASLD is frequently asymptomatic. Individuals can live for years with important fat accumulation in the liver without experiencing any noticeable symptoms. When symptoms do appear, they are often non-specific, such as fatigue, a feeling of fullness, or mild discomfort in the upper right abdomen. Diagnosis relies on identifying metabolic risk factors – obesity, hypertension, diabetes, and dyslipidemia – coupled with imaging evidence of hepatic steatosis (fatty liver), typically through ultrasound, while ruling out other potential causes like excessive alcohol consumption.
While progression to severe complications like cirrhosis or hepatocellular carcinoma is relatively uncommon, MASLD considerably elevates the risk of serious cardiovascular events, including heart attack and heart failure. It also exacerbates the likelihood of developing type 2 diabetes, chronic kidney disease, and certain cancers beyond the liver, such as colon and breast cancer.
New Hope on the Treatment Horizon
Managing MASLD requires a holistic, integrated strategy. This includes fundamental lifestyle modifications – weight management and a balanced diet – alongside emerging pharmacological interventions. Two recently approved medications, Resmetirom and Semaglutide, have demonstrated promising results in reducing liver fat and improving metabolic health in patients with steatohepatitis, the inflammatory form of MASLD.
The Future is Personalized
“MASLD is a multisystem disease that today represents a real public health challenge,” explains Professor Valenti. “To address it, a multidisciplinary and personalized approach is needed, based on lifestyle changes and the use of new therapies. Many open questions still remain, but research progress is paving the way for combined treatments aimed at the different genetic profiles of patients.”
Ultimately, MASLD is no longer viewed as simply a liver disease. It’s a critical indicator of the intricate connection between metabolic health and overall well-being. Early detection and a proactive, modern treatment approach are paramount to mitigating the growing impact of this silent epidemic.
