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Responding to Rise of Metabolic Liver Disease in Connecticut

January 27, 2025

Metabolic liver disease is on the rise in Connecticut. More than a third of people in the state are estimated to be living with metabolic dysfunction-associated steatotic liver disease (MASLD), including those with a more aggressive subtype of the disease, called metabolic dysfunction-associated steatohepatitis (MASH). People with these diseases (previously referred to as nonalcoholic fatty liver disease; NAFLD) have excess fat inside liver cells, which ultimately results in loss of normal liver function. MASLD and MASH can lead to end-stage liver disease including cirrhosis, and liver cancer.

“The dramatic rise of MASLD and MASH in Connecticut and across the country is alarming,” said Wajahat Mehal, MD, DPhil, professor of medicine (digestive diseases). “It is especially concerning because only a small percentage of people have a formal diagnosis. Many other people across the state have the disease but are not receiving diagnosis, treatment or surveillance.”

Mehal is the chair of a working group established by the Connecticut General Assembly to provide recommendations to increase awareness and education and improve public health infrastructure to respond to the increase in the prevalence of MASLD and MASH across the state.

“MASH is a leading cause of liver transplants and a common cause of chronic liver disease, yet there is little public awareness of this disease,” said Bubu Banini, MD, PhD, assistant professor of medicine (digestive diseases), who was co-chair of the working group. “There is a clear need for more state support to help increase public education and coordinate screening efforts to reduce the impact of MASH and MASLD.”

The working group developed 20 recommendations, which they shared with the Connecticut General Assembly Public Health Committee. Recommendations include:

  • Establish an annual Connecticut Liver Health Day to bolster awareness, education, and advocacy around liver health.
  • Establish new systems to screen people at high risk of MASH, including through electronic health records (EHRs) and non-invasive ultrasound technology in high-risk areas.
  • Develop outreach programs to educate key audiences and stakeholders about the disease. Audiences include primary care providers, pediatricians, community health workers, teachers and school health workers, middle and high school students, and community organizations in Hispanic communities, among others.
  • Highlight several key points during educational efforts, including the role of moderate alcohol intake in increasing the likelihood and severity of liver disease
  • Include chronic liver disease in the State Health Dashboard to provide visibility and awareness of the rise in prevalence of the disease.

“We hope that the members of the Public Health Committee will carefully consider these recommendations and take action to adopt many of them as state law,” said Jorge Moreno, MD, assistant professor of medicine (general internal medicine), who also served as a member on the panel. “With better education and screening, we can work together to bring down rates of MASLD and MASH within Connecticut and improve the health of our population—particularly the Latinx population, which is more significantly affected by these conditions.”

The working group sent the complete recommendations to the General Assembly in January 2025. The full report is available online for the public to review.

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