Over 15 million people across the US, UK, Germany, and France may unknowingly be living with the most aggressive form of fatty liver disease, according to new research published in The Lancet Regional Health Europe.
The condition, known as metabolic dysfunction-associated steatohepatitis (MASH), is a progressive form of MASLD (formerly called non-alcoholic fatty liver disease). MASH causes liver inflammation and scarring, which can progress to cirrhosis or liver failure if left untreated. It can also lead to kidney disease or heart-related complications.
Although MASH poses serious health risks, the study found that diagnosis rates are extremely low. In the four countries studied, an estimated 20 million people have MASH, yet only 2.5 million have received a formal diagnosis.
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The report highlights that less than 18% of individuals with MASH have been diagnosed. “Unless we double diagnosis rates and improve treatment access, the cost, both human and economic, will be enormous,” said Dr Jeffrey Lazarus, lead author and global health professor.
High-risk groups, particularly people with type 2 diabetes, obesity, and elevated liver enzymes, are urged to undergo routine screening. Experts warn that two-thirds of people with type 2 diabetes likely have MASLD or MASH, often without symptoms.
The study also renews focus on the use of weight-loss drugs like Wegovy, Mounjaro, and GLP-1 receptor agonists to treat MASH. “These medications help control appetite and metabolism, leading to weight loss and improved liver function,” said Dr Paul Brennan, co-author and hepatologist at NHS Tayside.
Experts are now calling for urgent liver health assessments in people with diabetes and obesity.
“Millions are walking around with a silent, deadly disease,” said Prof. Emmanouil Tsochatzis, a hepatologist at University College London. “We need faster diagnoses and proactive treatment before it’s too late.”
