This disease might be silently killing millions quietly, says research. Are you at risk?

A recent international study has revealed that millions of people in the US and Europe may be unknowingly living with a dangerous form of fatty liver disease. Published in The Lancet Regional Health Europe, the research indicates that a vast number of individuals are affected by metabolic dysfunction-associated steatotic liver disease (MASLD), with the majority still undiagnosed.
Widespread but Largely Undetected
The study examined populations in the United States, United Kingdom, Germany, and France, and found that approximately 20 million people across these countries have the more severe variant of MASLD known as metabolic dysfunction-associated steatohepatitis (MASH). Alarmingly, only about 2.5 million have received a formal diagnosis. This means roughly three-quarters of those with the disease—an estimated 16.7 million individuals—remain unaware of their condition.
MASLD is the updated term for non-alcoholic fatty liver disease (NAFLD), and it affects people whose liver contains over 5% fat despite little or no alcohol intake. While many patients only develop the earliest and less severe stage known as simple fatty liver, the disease can progress without symptoms and cause serious damage over time.
Progressive and Potentially Fatal
MASH, the aggressive form of the disease, is associated with inflammation and can lead to fibrosis, or scarring of the liver. If not managed, it may progress to cirrhosis, a stage marked by irreversible liver damage and potential liver failure. The condition is also linked to higher risks of cardiovascular issues, chronic kidney disease, and liver cancer.
The study's findings emphasize the urgency of early diagnosis, especially as MASH is particularly common among people with type 2 diabetes and those who are overweight or obese. Researchers noted that around two-thirds of individuals with type 2 diabetes are thought to have MASLD.
Urgent Need for Diagnosis and Treatment
Dr. Jeffrey Lazarus, the lead author of the study, stressed the economic and health burden posed by undiagnosed MASH. He pointed out that without a significant increase in diagnosis and treatment, the financial costs to healthcare systems could triple over the next two decades.
Prof. Emmanouil Tsochatzis of University College London echoed this warning, stating that over 15 million people in the US and Europe are living with the most severe form of fatty liver disease without knowing it. He warned that both human suffering and economic consequences could worsen significantly if diagnosis rates do not improve.
Traditionally, MASH has been diagnosed through liver biopsy, but newer, non-invasive tools such as blood tests, ultrasound, and MRI scans have made screening easier. Experts now recommend that individuals with type 2 diabetes, obesity combined with other risk factors, or persistently elevated liver enzymes undergo regular screening.
Potential Role of Weight Loss Medications
The study has also brought renewed attention to the potential of weight loss medications to help manage MASH. Dr. Paul Brennan, a hepatologist and co-author of the study, highlighted the promise of GLP-1 agonists like Wegovy and Mounjaro. These drugs work by reducing appetite and slowing digestion, leading to weight loss, which in turn may help reduce fat accumulation and scar tissue in the liver.
Michael Betel, president of the Fatty Liver Alliance, stressed that individuals with type 2 diabetes or obesity are often not screened for MASH until significant liver damage has occurred. He called for broader liver health assessments and, when appropriate, the use of weight loss drugs as part of a comprehensive treatment strategy.
A separate study released around the same time found that the diabetes drug dapagliflozin not only helps reduce blood sugar but also lowers fat and scarring in the liver, suggesting another potential treatment pathway.
Risk Factors and Screening
According to health authorities like the NHS, those at greater risk of MASLD include people who are overweight, have type 2 diabetes, high blood pressure, high cholesterol, metabolic syndrome, or are over the age of 50. Smoking and thyroid disorders may also increase the risk.
Doctors typically begin diagnosis with blood tests that show elevated liver enzymes. If abnormalities are detected, further assessments such as imaging scans or liver elastography (FibroScan) are used to evaluate liver fat and fibrosis levels.
With the growing prevalence of MASLD and MASH, the study underscores the critical importance of early screening, timely intervention, and broader public health awareness to address this hidden but escalating health threat.

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