EMERGING evidence highlights the need for routine liver risk stratification in people with obesity, with implications for early detection and management of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH), researchers reported this week.
Rising obesity fuels liver disease risk
Obesity is a well-recognised driver of liver fat accumulation and inflammation and is now the most rapidly growing indication for liver transplantation worldwide. Authors emphasised that obesity-related MASLD deserves dedicated risk stratification because of its close links to liver fibrosis, cirrhosis, hepatocellular carcinoma (HCC), and cardiovascular complications.
Although MASLD is common, it often remains undiagnosed until advanced stages, when liver damage may be irreversible. According to the authors, identifying individuals at high risk earlier, particularly those with obesity and metabolic dysfunction, could facilitate timely interventions and prevent progression to more severe disease.
Why risk stratification matters
Existing approaches to MASLD management have focused primarily on lifestyle interventions and metabolic control, but the correspondence underscored that a risk-based strategy should become a standard component of clinical care. The authors argue that routine assessment of liver risk in people with obesity can help clinicians prioritise surveillance and therapeutic decisions, similar to how cardiovascular risk is routinely stratified in primary care.
Routine risk stratification encompasses evaluation of clinical risk factors such as waist circumference, insulin resistance, and dyslipidaemia, combined with non-invasive tests for liver fibrosis and fat. These assessments can help identify patients with early or advanced liver disease, enabling targeted follow-up and referral to hepatology services.
Implications for hepatology practice
The authors noted that earlier stratification and diagnosis could reduce the burden of advanced liver disease on healthcare systems by promoting earlier lifestyle and therapeutic measures. They also highlighted the importance of integrating liver risk assessment into routine practice for people with obesity, diabetes, or metabolic syndrome – groups at particularly high risk of MASLD and related complications.
While the consensus is not yet formalised into clinical guidelines, the emphasis on systematic liver risk stratification reflects a growing recognition that early is critical in managing the global crisis of MASLD.
Reference
Rinella ME et al. MASLD as a complication of obesity must include liver risk stratification. Nat Med. 2026;DOI:10.1038/s41591-025-04130-7.
