Scientists call for more efforts to diagnose liver disease MASH
Diagnostic tools could end public health threat, paper says
An international team of scientists called for more efforts to diagnose metabolic dysfunction-associated steatohepatitis (MASH), a severe form of fatty liver disease, arguing that advances in diagnostic tools and better treatments could eliminate the disease as a public health hazard within five years.
The researchers made their case in a paper, “A call for doubling the diagnostic rate of at-risk metabolic dysfunction-associated steatohepatitis,” published in The Lancet Regional Health Europe.
“The future of the fight against MASH lies in anticipation: not only treating advanced patients but also identifying those without fibrosis [liver scarring] early on,” Jeffrey Lazarus, PhD, the study’s first author and head of the Public Health Liver Group at the Barcelona Institute for Global Health in Spain, said in an institute press release. “This shift towards preventive [liver health-related strategies] is key to improving the metabolic health of millions around the world.”
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a form of fatty liver disease marked by the buildup of fat in the liver. It is typically associated with metabolic conditions such as obesity, high blood pressure, or diabetes.
For some people, MASLD can progress to MASH, in which fat accumulation gives rise to liver inflammation and scarring that can set the stage for life-threatening complications like liver failure and liver cancer.
‘Missed opportunity’ for earlier diagnosis
Current worldwide estimates suggest that nearly 1 in 3 adults has MASLD and about 1 in 20 has MASH. However, most people with these conditions don’t know it, because symptoms of these liver diseases don’t usually manifest until the disease has progressed to the point of causing liver failure or cancer.
This means that many people with MASH aren’t diagnosed until very late stages of the disease, when it’s harder to treat the disease.
“Each late-stage MASH diagnosis represents a missed opportunity for earlier intervention to prevent disease progression, threatening worse [liver and non-liver] outcomes for people living with the condition and greater costs for individuals, health systems, and societies,” the researchers wrote.
The scientists’ plan for changing that starts with routine testing for MASH in people with diabetes, obesity, and other cardiometabolic risk factors, or who have persistently elevated blood levels of liver enzymes, a marker of liver damage.
Ideally, such testing could be performed in settings like primary care doctors’ offices, so patients don’t have to travel to liver specialty clinics for separate appointments. That would involve expanding the use of liver disease diagnostic tools.
The scientists also are calling on the field to embrace new technologies that could make diagnosing MASH faster and more efficient. For example, cutting-edge machine learning models may be used to help identify people at high risk of MASH for further testing.
Hand in hand with the development of new diagnostic tools will come the development of new liver disease treatment options, the scientists said. As more treatments become available, patients will be more likely to seek out diagnoses, which should help create incentives for more easily accessible testing, they reasoned.
“Innovations in diagnostics will facilitate quicker, more accurate, and easier-to-use tools,” they wrote. “Alongside this, a growing treatment toolkit will drive greater demand for MASH diagnosis among people living with the disease, which should lead to a broadening of testing within and across healthcare settings.”
Prioritizing the person
New technologies and better treatments have radically changed care for other diseases over the course of a decade or two, the researchers noted. There’s every reason to think such changes are possible for MASH, they argued, as long as clinicians and advocates are willing to put in the work to make it happen.
“The next years should be characterised by concerted multistakeholder efforts encompassing an expansion of the community of practice, enhancement of health system operational readiness, and rapidly expanding disease diagnosis to provide treatment and care for the hundreds of millions of people living with MASLD globally, making a special effort for those living with at-risk MASH,” the scientists wrote. “We have the knowledge, tools, and opportunity to end this public health threat by 2030.”
In parallel, Lazarus and more than 40 other experts published a comment, The People-First Liver Charter, in Nature Medicine, in which they call for “a shift towards person-centred language and care models that prioritise the individual over the diagnostic label,” the institute said.
That proposed approach, endorsed by more than 70 organizations around the world, aims to end the stigma around liver diseases that often results in delayed diagnosis and treatment. It goes in line with recent global efforts to rename the several forms of fatty liver diseases with more inclusive terms to prioritize patient dignity and empowerment.
“Reducing the stigma and discrimination that people living with liver conditions experience requires rethinking how diagnoses, diseases, [causes] and circumstances are perceived — a shift that begins with the language used to name and describe them,” the researchers wrote.
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