Diagnosing MASH (Liver Disease): A Meaningful Opportunity for Early Detection

MASLD, MASH, and liver disease rarely come up as a widespread public health concern. Cancer, diabetes, heart disease, and obesity capture many column-inches of reporting and commentary. Television commercials highlight eczema, ED, and incontinence. And the Covid-19 pandemic focused attention not only on infectious disease, but also on mental health needs and a loneliness crisis.

Most are surprised to learn, then, that about 25% of adults have liver disease. [1] Metabolic-associated steatotic liver disease (MASLD) and its more severe form, metabolic dysfunction-associated steatohepatitis (MASH), represent significant challenges in modern healthcare. A 20-year community study found that MASLD – traditionally known under the umbrella term non-alcoholic fatty liver disease (NAFLD) – “reduced life expectancy by 4 years.” [1] Thus, addressing liver disease in the early stages is crucial for improving patient outcomes and reducing healthcare costs.

 

Understanding MASH (Liver Disease in Earlier Stages)

MASLD is characterized by excessive fat accumulation in liver cells rather than alcohol consumption. When MASLD progresses to MASH, it indicates inflammation and liver cell damage along with fat buildup, potentially leading to cirrhosis and liver cancer. Risk factors for MASLD/MASH include obesity, type 2 diabetes, and dyslipidemia.

The disease often remains asymptomatic until it progresses to advanced stages, making it a silent yet precarious health condition. With obesity rates continuing to rise, alongside increases in type 2 diabetes, the prevalence of MASLD and MASH pose an escalating public health challenge [2]. Combined with a growing shortage of specialty physicians in areas like hepatology and gastroenterology, MASLD and MASH could emerge as another public health crisis.

These trends emphasize the importance of early diagnosis.

 

The Impact of Medical Advancements on Early Diagnosis

The development of non-invasive diagnostic tools has helped impact the early detection of MASLD and MASH. Tools like FibroScan and MRI-PDFF allow clinicians to accurately assess liver fat and fibrosis without the need for invasive liver biopsies. In one example, a company has developed (for research use only, so far) a proteomics-based assessment that detects 11 plasma proteins correlating with liver fat, inflammation, and fibrosis [3]. Advancements like this provide safer alternatives to biopsy, increasing the feasibility of larger-scale screenings.

Artificial intelligence and machine learning further refine these diagnostic capabilities. By analyzing patient data, these technologies can predict the likelihood of disease progression with impressive accuracy, facilitating early intervention strategies.  They are also able to do this analysis without requiring significant IT or clinical resource outlays by healthcare organizations.

By combining innovative forms of detection and treatment, there is significant opportunity to make early diagnosis a reality for MASH and MASLD.

 

Socio-Economic Implications of Early Detection

The economic burden of MASLD and MASH is substantial, attributed to both direct medical costs and indirect costs such as lost productivity. According to a study by Younossi et al. (2020), NAFLD (the previously used term for MASLD) accounts for approximately $103 billion of annual healthcare spend in the U.S. alone. [4] Early diagnosis can save billions by reducing the need for costly interventions at advanced disease stages.

Moreover, patients experience a significant quality of life improvement with early action, emphasizing the necessity of integrating early diagnosis into routine healthcare practices. By finding the disease earlier and accelerating treatment, there is an opportunity to reduce the 4 years of life lost associated with MASLD/MASH. [5]

 

The Role of Healthcare Professionals

A multi-disciplinary approach involving specialists in hepatology, gastroenterology, endocrinology, and nutrition is particularly successful in managing MASLD and MASH. Hospitals and clinics may want to prioritize educational programs that raise awareness among healthcare providers about the significance of early intervention. The implementation of non-invasive tests empowers providers to screen patients more frequently and effectively without the risks or costs associated with traditional biopsy procedures.

 

Innovations in Treatment and Management

Lifestyle changes, including diet and exercise, remain vital in managing MASLD. However, new pharmacological treatments promise to address disease pathology at the molecular level. Drugs targeting glucagon-like peptide-1 (GLP-1) receptors, for instance, show efficacy in reducing liver fat and inflammation, providing new hope for patients [6]. Moreover, ongoing clinical trials focus on therapies that aim to block metabolic pathways responsible for liver disease progression, shifting toward more personalized, patient-centric treatment models [7].

 

Navigating Challenges in the Fight Against MASH & Liver Disease

The most important MASH related diagnostic consideration may not be that it will be the primary cause of death, but that it reveals the severity of comorbidities such as type 2 diabetes, obesity, and cardiovascular disease. These health concerns are often the main causes of mortality among patients with MASH and the presence of MASH underscores the urgency of managing them. As noted above, MASLD and MASH are associated with lower life expectancy, complicating and accentuating the impact of other chronic disease.

Furthermore, clinician education plays a vital role in overcoming obstacles in the battle against MASH. Healthcare professionals want the latest knowledge and guidelines pertaining to the diagnosis, treatment, and management of liver disease and the stages that precede it. This education ensures that providers can recognize early signs of the disease, understand its complex nature, and advocate for effective patient management strategies. Additionally, informed healthcare professionals are better positioned to dispel myths associated with MASH, thereby reducing disease related stigma more effectively engaging their patients. By better educating providers, the medical community can improve patient outcomes and contribute to the broader mission of curtailing the prevalence and impact of MASH.

 

Conclusion

Through technological advancement and greater disease awareness and understanding, early diagnosis and intervention can reshape the landscape of liver disease management, offering improved outcomes and reduced healthcare costs. The healthcare community must continue to innovate and educate to ensure these advancements reach those who need them most.

By embracing and promoting widespread adoption of MASH/MASLD related innovation, clinicians will play a vital role in transforming liver disease management and patient care for millions around the world.

Stay tuned for upcoming posts in this series, where we dig deeper into:

• Reasons for and the implications of renaming NALFD/NASH to MASLD/MASH.
• The economic benefits of early liver disease detection for provider organizations.
• Why there is a need to augment current liver disease diagnostic testing methods.
• The future of liver disease treatment and the next class of drugs to help combat this growing problem.