A Silent Condition with Growing Impact
Liver disease linked to metabolic dysfunction is no longer a niche concern. It is increasingly recognised as one of the most common chronic conditions worldwide, yet it remains underdiagnosed and often overlooked in routine care.
A key reason for this is its silent nature. In its early stages, excess fat in the liver rarely causes noticeable symptoms. Many people are unaware anything is wrong until the disease has already progressed.
“Having excess fat in the liver is a very prevalent condition worldwide, 30% of the world’s population have it,” Manuel explains. “Even if only a small proportion develop more severe disease, the total number of patients becomes very large.”
This scale presents a paradox. While the individual risk of progression may be relatively low, the overall burden on healthcare systems is significant and growing.
The Missing Piece in Cardiovascular Risk Assessment
Despite strong links between liver health and other major conditions like cardiovascular disease, the liver is still not consistently included in standard clinical evaluations.
Today, cardiovascular risk assessments typically focus on factors such as blood pressure, smoking, cholesterol, glucose levels, and body weight. These are all critical indicators, particularly for cardiovascular disease. However, they do not tell the full story.
“Clinicians look at traditional risk factors like hypertension, cholesterol, glucose,” Manuel says. “But they don’t always look at the liver, while excess liver fat can significantly increase cardiovascular risk.”
This gap matters. Evidence shows that liver fat is not just a consequence of metabolic dysfunction, but also a driver of further cardiovascular complications. When combined with conditions like diabetes, the risk of serious outcomes increases substantially.
Integrating liver health into routine cardiovascular assessments could therefore provide a more complete picture of patient risk and enable earlier, more targeted interventions.
Changing the Way We Screen
At GRIPonMASH, we are working to make this shift possible by redesigning how liver disease is detected in practice.
Our approach begins with identifying individuals at higher risk, particularly those living with obesity or diabetes. From there, we apply a structured, non-invasive screening pathway that combines blood-based biomarkers with imaging techniques.
These imaging tools, similar to ultrasound, allow clinicians to assess not only fat accumulation in the liver, but also inflammation and scarring. This is vital, as disease progression is closely linked to the development of fibrosis.
“Thanks to these technologies, we can build a clear picture of how healthy the liver is,” Manuel explains. “This helps us identify the very high risk people who are more likely to have MASLD or MASH and based on that information we can proceed with further, more sophisticated and invasive tests to establish the diagnosis.”
From Diagnosis to Empowerment
One of the most encouraging aspects of liver disease is that, in its early stages, it is often reversible. The liver is a resilient organ, capable of recovering when given the right conditions.
“If people understand their situation and change their lifestyle, the liver can improve,” Manuel noted.
This makes early detection particularly valuable. When individuals are made aware of their liver health before significant damage occurs, they have a real opportunity to take action.
In practice, this often involves changes in diet, increased physical activity, and weight management. While these may sound like familiar recommendations, their impact on liver health can be profound.
Screening, in this sense, becomes more than a diagnostic tool. It becomes a starting point for engagement, helping people understand their health and motivating them to improve it.
Embedding Innovation in Healthcare Practice
Scientific and technological advances are opening new possibilities for liver screening. From AI-driven risk prediction to novel biomarkers and organ-on-chip models, these innovations are central to the work of GRIPonMASH and are helping to push the boundaries of what is possible in early detection.
But innovation alone is not enough.
Even the most advanced tools will have limited impact if they are not adopted in clinical practice or supported by healthcare systems. Moving from promising technologies to real-world use requires more than scientific validation—it depends on awareness, education, and alignment across stakeholders.
This is where policy plays a key role.
Integrating liver screening into routine care pathways depends on decisions made at national and European levels, including clinical guidelines, reimbursement structures, and broader public health priorities. Without this support, even the most effective screening approaches risk remaining underused.
Engaging with policymakers is therefore a central part of our work. It allows us to highlight both the scale of the challenge and the feasibility of solutions, while ensuring that liver health is part of the broader healthcare conversation.
“We need to raise awareness, not only among patients, but also among healthcare professionals and decision-makers,” Manuel emphasized. “These conditions are very common and cause significant harm, but there is still not enough attention.”
Ultimately, the goal is to ensure that liver health is no longer treated as a secondary concern, but as an integral part of managing metabolic and cardiovascular risk.
“My dream would be to include liver screening in regular care,” he adds. “Because we know it plays an important role, and right now it is often overlooked.”
Supporting Care in Practice
As GRIPonMASH progresses, with thousands of participants already enrolled and screening continuing across Europe, the focus is increasingly shifting toward impact.
The insights generated through this work have the potential to inform not only future research, but also clinical guidelines and healthcare policy. The ultimate goal is clear: to move from pilot programmes and projects to widespread, sustainable implementation.
Making liver screening routine will not happen overnight. It requires coordinated effort across research, healthcare systems, and policy frameworks. But the foundations are being laid.
By combining large-scale data, innovative diagnostics, and active engagement with stakeholders, we are working toward a future where liver health is no longer invisible and where early detection is routinely integrated into care.
