Metabolic dysfunction-associated steatotic liver disease (MASLD) screening strategies: from non-invasive tests to multidisciplinary care models

Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by fat accumulation in the liver (steatosis). At least 38% of adults are affected by MASLD, and this percentage increases up to 70% in individuals with comorbidities such as type 2 diabetes or obesity. Over time, MASLD can progress into more severe forms: metabolic dysfunction-associated steatohepatitis (MASH) and liver fibrosis. MASLD is often diagnosed late, as the early stages are asymptomatic and the disease remains relatively unknown. Several non-invasive tests have been developed to detect advanced forms of MASLD at an early stage. The most recent guidelines recommend using these tests in a stepwise manner to improve the detection of liver fibrosis, reduce indeterminate test results, and ultimately minimize the need for liver biopsies. The first part of this thesis focuses on screening. A global survey demonstrated that knowledge gaps remain among healthcare professionals, particularly cardiologists and general practitioners. The GRIPonMASH consortium facilitates and investigates large-scale screening among 10,000 high-risk patients across Europe. Preliminary results showed that the prevalence of MASLD (and its progressive stages) did not differ between participants screened after identification in primary care or at outpatient clinics, underscoring the importance of broad implementation. The second part of this thesis examines the relationship between non-invasive tests and cardiovascular risk. Analyses of previous clinical trials (PROSPER, CLEAR Outcomes, AleCardio) show that elevated test scores for liver steatosis/fibrosis are associated with increased cardiovascular risk. Statins and bempedoic acid demonstrated beneficial effects in specific subgroups. The thesis concludes that MASLD is an important yet overlooked metabolic disorder. Integrating liver health into broader cardiovascular and metabolic care pathways is essential, with a central role for multidisciplinary and holistic approaches.