A surge of new research warns of a growing, largely hidden health crisis: metabolic dysfunction-associated steatohepatitis (MASH). Known as a silent liver disease, MASH affects millions but remains undiagnosed in many cases. Recent studies in major medical journals and consolidated summaries highlight that a large majority of people with this dangerous fatty liver condition do not know they have it. In Thailand, experts say trends mirror global patterns driven by urban lifestyles, obesity, and metabolic syndrome.
MASH tends to progress quietly until serious damage appears. It involves excess fat buildup in the liver, causing inflammation and scarring that can advance to cirrhosis. This raises the risk of heart and kidney disease and, in severe cases, liver cancer or organ failure. As lifestyle habits change worldwide, the number of MASH cases is projected to rise. An Asia-Pacific liver health overview estimates fatty liver disease could climb from about 39% of adults in 2020 to roughly 56% by 2040. Thai clinicians note local trends align with these projections due to rapid urbanisation and dietary shifts.
Warning signs are often subtle: fatigue, mild stomach discomfort, weight changes, and weakness. By the time diagnosis occurs, the liver may already be scarred, limiting treatment options. International researchers stress that late diagnoses lead to missed opportunities for early intervention and higher costs for individuals and health systems. In the United States, only about one in five people with MASH are aware of their condition; similar underdiagnosis is seen in Europe and Asia, reflecting outdated screening approaches and limited access to specialist services.
New regional guidelines from the Asian Pacific Association for the Study of the Liver emphasize earlier and broader screening, especially for high-risk groups such as people with obesity, diabetes, or heart disease. Data indicate that up to 60% of people with type 2 diabetes and nearly 90% of those with obesity may develop MASH at some stage. For Thailand, these messages are timely, as recent estimates suggest a substantial portion of Thai adults live with some form of MASLD/MASH, though formal liver screening remains uncommon in primary care outside major cities.
Undiagnosed MASH has wide-ranging consequences. Beyond progression to liver failure, individuals with MASH are about three times more likely to develop serious heart conditions. The economic impact is substantial; in the United States, MASH-related illnesses cost more than $100 billion annually. As Thailand’s population ages and absorbs lifestyle changes, similar costs and health burdens could rise unless prevention, screening, and early intervention are prioritized.
Protective steps are available. Early lifestyle changes—healthy eating, regular physical activity, and modest weight reduction (about 5-10% of body weight)—have proven to slow or partly reverse disease progression. In March 2024, resmetirom became the first medication approved in the United States specifically for MASH, signaling growing therapeutic interest. Other drugs, including SGLT-2 inhibitors and GLP-1 receptor agonists, are being explored for their potential in reducing liver inflammation while also addressing metabolic conditions.
Experts agree that the core change is a shift in care delivery: screening should move from specialist liver clinics into primary care, diabetology, cardiology, and family practice. Integrating non-invasive liver tests into routine checks—for example during diabetes or hypertension evaluations—could identify high-risk individuals earlier. Automated flagging within electronic medical records is being piloted in several countries to prompt timely testing.
Public health messaging is also crucial. Campaigns must raise awareness about fatty liver disease, challenge misconceptions, and reduce stigma—particularly where liver illness is wrongly linked to alcohol use. Thailand’s health landscape has moved from infectious diseases to chronic non-communicable conditions, a shift shaped by diet and lifestyle changes since the 1980s. The rising popularity of fast food and sugary drinks underscores the need for proactive liver health strategies.
In practice, Thai clinicians urge viewing MASH as a multisystem threat, not solely a liver issue. A Bangkok-based hepatologist recently emphasized proactive screening for patients with diabetes or cardiovascular disease, even if they feel well, to enable early detection and intervention.
Thailand has taken steps toward integration. National guidelines now encourage annual liver enzyme testing for high-risk individuals in chronic disease clinics. Yet implementation varies, particularly in rural areas where resources are more limited. The latest regional guidelines stress the importance of early detection and widespread screening to curb disease progression.
Looking ahead, experts anticipate a turning point in the next few years. Broader use of new therapies and smarter screening could transform MASH management, especially if primary care takes the lead and public health messages reach diverse communities. In the meantime, individuals at higher risk—those who are overweight, have diabetes or hypertension, or a family history of liver disease—should discuss liver health with their clinicians. Simple tests can catch problems before they become irreversible, and even modest weight loss can yield meaningful benefits for liver health and overall well-being.
From a public health perspective, Thailand stands at a pivotal moment. Translating cutting-edge research into everyday care and empowering primary care teams to conduct routine liver health checks will be essential. Early identification and intervention for metabolic liver disease should be integral to Thailand’s ongoing efforts to prevent chronic illness and protect the health of communities for years to come.
For people seeking information or liver screening, consult local health centers or chronic disease clinics and start conversations with healthcare providers about liver health. Early action can prevent the silent spread of this modern epidemic.