A new wave of research has sounded the alarm on a widespread but often overlooked health threat: metabolic dysfunction-associated steatohepatitis (MASH), a “silent disease” that afflicts about 16 million Americans—most of whom don’t know it. Recent studies published in major medical journals, including The Lancet and findings summarized by the Daily Mail, reveal that a staggering 80% of those living with this deadly form of fatty liver disease remain undiagnosed, raising urgent concerns for public health systems, including here in Thailand (source, Wikipedia, Asia-Pacific Trends PDF).
Often progressing with little or no symptoms until serious, irreversible harm sets in, MASH is characterized by an unhealthy build-up of fat in the liver, causing inflammation and scarring. This process can progress to cirrhosis, drastically elevate the risk of heart and kidney disease, and in severe cases, lead to liver cancer or sudden organ failure.
With global lifestyle habits shifting and chronic diseases like obesity and type 2 diabetes on the rise, the number of MASH cases worldwide is expected to soar. According to projections outlined in a recent Asia-Pacific liver health overview, the prevalence of fatty liver disease is expected to climb from about 39% in 2020 to nearly 56% by 2040 (Trends in Asia-Pacific). In Thailand, regional experts warn that these upward trends are mirrored locally due to rapid urbanisation, changing diets, and increased rates of metabolic syndrome.
Unlike many chronic illnesses, MASH typically arrives with warning signs so subtle that they are easily dismissed: fatigue, mild abdominal discomfort, unexplained weight loss, weakness, and, in advanced cases, jaundice. Most patients are only diagnosed when their liver is already scarred—leaving only limited treatment options. As one coalition of international researchers recently warned, “Each late-stage MASH diagnosis represents a missed opportunity for earlier intervention to prevent disease progression, threatening worse outcomes for people living with the condition and greater costs for individuals, health systems, and societies.”
In the United States, only about one in five affected individuals are actually aware of their condition, and studies show similar underdiagnosis in Europe and Asia (Wikipedia: MASLD). The low awareness is partly due to the disease’s stealthy nature but also reflects outdated screening and diagnostic systems that rely too heavily on symptom-based triggers or access to expensive specialist services. Recent research published in The Lancet has called for a doubling of diagnostic rates just to keep up with the growing tide of cases.
New guidelines from the Asian Pacific Association for the Study of the Liver, released in early 2025, echo this sentiment. Experts emphasize the urgent need for earlier, more widespread screening—especially among high-risk groups: people living with obesity, diabetes, or established heart disease (Springer: Regional Guidelines). In fact, up to 60% of people with type 2 diabetes and nearly 90% of those living with obesity are expected to develop MASH at some stage in their lives.
For Thailand, this message comes at a crucial time. Data suggests nearly 38% of all Thai adults may have some form of metabolic dysfunction-associated steatotic liver disease (MASLD), with MASH occupying the most severe end of the spectrum ([Epidemiology PMC]]>
https://pmc.ncbi.nlm.nih.gov/articles/PMC11925440/)). This burden is likely understated, as formal liver health screening remains uncommon in primary care, particularly outside large urban centers.
The cascading effects of undiagnosed MASH are multifaceted. Beyond advancing to liver failure, people with MASH are three times more likely to develop serious heart conditions, such as coronary artery disease and stroke. The economic impact is significant: in the United States alone, MASH-related illnesses cost over US$100 billion annually. As Thailand’s population grows older and heavier—a trend mirrored throughout East Asia—such invisible costs are expected to escalate rapidly unless prevention, screening and early interventions are prioritized.
Experts emphasize that MASH is neither unpreventable nor untreatable if caught early. Lifestyle changes, including healthier eating, increased physical activity, and modest weight loss (5-10% of body weight), are proven to slow or even partially reverse the disease’s progression (Wikipedia: MASLD treatment). In March 2024, the U.S. FDA approved resmetirom, the first medication specifically for MASH—a milestone reflecting growing scientific and pharmaceutical attention (PubMed: Resmetirom Population Study). Several other drugs, including SGLT-2 inhibitors and GLP-1 receptor agonists, are currently being evaluated for their role in managing not just sugar levels but underlying liver inflammation.
However, what remains most critical, according to the international coalition cited in The Lancet, is “a fundamental reworking of methods of care that catches at-risk patients before irreversible damage occurs.” This requires moving screening from specialist liver clinics into the hands of general practitioners, diabetologists, cardiologists, and family doctors—a point repeatedly underscored by both Western and Asian clinical guidelines (Springer: Regional Guidelines, EASL-EASD-EASO Guidelines). The intention is to capitalize on every opportunity, such as routine diabetes or hypertension checks, to identify high-risk individuals earlier.
One promising strategy already being piloted in several countries is the use of automated flagging and screening tools within electronic medical records. These systems can identify patients with diabetes, obesity, or metabolic syndrome and prompt their physicians to order non-invasive liver tests as part of standard chronic disease management protocols.
In parallel, public health campaigns are needed to raise awareness about the silent threat of fatty liver disease, combat persistent misconceptions, and destigmatize the diagnosis—especially in cultures where liver illness is often mistakenly associated with alcohol abuse.
Historical insights reveal that Thailand’s changing health profile—moving from infectious diseases toward chronic, non-communicable illnesses—has mirrored economic and dietary shifts since the 1980s. The rising popularity of fast food, sugar-sweetened beverages, and sedentary lifestyles has contributed to epidemics of obesity and diabetes, which form the foundation for a climbing MASLD and MASH burden (Asia-Pacific Trends PDF).
Thai healthcare practitioners are also urged to view MASH not just as a liver issue, but as a multisystem threat. As one leading Thai hepatologist from a major Bangkok teaching hospital explained at a recent liver health symposium, “We need to proactively screen our patients with diabetes or cardiovascular disease for liver health—even if they feel fine. Early detection is key.”
Thailand has already taken early steps: national health guidelines now recommend that high-risk groups receive annual bloodwork to check liver enzymes, especially those registered in chronic disease clinics. However, implementation remains inconsistent, particularly in rural communities where access and resources lag behind the needs identified in the latest research (Asia-Pacific Guidelines).
Looking ahead, both global and local experts anticipate that the next three years could mark a tipping point for MASH recognition and care. Major pharmaceutical advances—such as the wider adoption of resmetirom and other pipeline medicines—offer hope for treatment where lifestyle changes alone prove insufficient. Yet, as highlighted by the international research team, true progress depends on building systems for routine screening, empowering primary care to take the lead, and ensuring that public health messages resonate in diverse communities across Thailand and the region.
For now, the best advice for individuals—especially those carrying extra weight, living with diabetes or high blood pressure, or with a family history of liver disease—is to talk to their healthcare provider about liver health. Simple blood tests and non-invasive scans are increasingly available and could catch silent problems before they become irreversible. For those already diagnosed, research reinforces that losing even just 5-10% of body weight can make all the difference, potentially restoring years of healthy life.
From a public health perspective, Thailand stands at a crossroads—opportunity lies in translating the latest scientific advances and international best practices into everyday, accessible care. Early identification and intervention for metabolic liver disease should be seen as an essential component of Thailand’s ongoing effort to prevent chronic diseases and safeguard the health of its population for generations to come.
For more information or liver screening, readers are encouraged to consult with their local health centers or chronic disease clinics. Proactive conversations and early action may prevent the silent spread of this modern epidemic.