NYC Gazette

Columbia University Vagelos College of Physicians and Surgeons is making strides in the early detection and treatment of metabolic dysfunction-associated steatotic liver disease (MASLD). Dr. Julia Wattacheril, a hepatologist at Columbia, is leading efforts to address this prevalent but often underrecognized condition.

Dr. Wattacheril notes that public comments on media stories about fatty liver disease reveal significant gaps in communication: "I always learn a lot from what the public asks in the comment sections in public health pieces, it really reveals the gaps in communication," she says. MASLD affects approximately 30-40% of U.S. adults and up to 45% globally, yet awareness remains low among patients and healthcare providers.

The challenge with MASLD is its asymptomatic nature during early stages, often resulting in late diagnosis when cirrhosis has already developed. "Expertise is limited, and I'm fortunate if a patient is referred to me after someone recognizes the risk factors and does a test," says Wattacheril.

To improve identification rates, Dr. Wattacheril has developed an innovative technology that analyzes electronic health records (EHR) for potential MASLD cases using natural language processing. This approach identified around 16,000 potential patients at Columbia University alone, many without previous diagnoses.

"Our machine-based algorithm is flagging patients who have scar tissue and don't know it," says Wattacheril. The technology acts like an automated physician by quickly analyzing lab data, clinical notes, and radiology reports without relying on machine learning or AI—though future versions may incorporate these technologies cautiously.

Dr. Wattacheril's team plans to validate their software through human trials soon: "We are about to start our first in-human trial to validate the software’s diagnoses and stratifications." They aim to connect identified patients with research-related testing for confirmation.

New therapeutic options for MASLD have emerged recently, including lifestyle changes and new medications that reduce scarring in advanced forms of the disease like MASH (metabolic dysfunction-associated steatohepatitis). "We are in a different era of therapeutics... Therefore we need to meet that new era with new technologies such as software as a medical device," explains Wattacheril.

The ultimate goal of this algorithm is precision medicine by categorizing patients into different MASLD types for tailored treatments: "A lot of people will benefit from new GLP-1 drugs... but other patients have less-common forms...and will need other approaches."

Dr. Julia Wattacheril serves as an associate professor at Columbia University Vagelos College of Physicians and Surgeons' Department of Medicine within its Division of Digestive & Liver Diseases.