The City of Bergamo Kicks Off MASH Cities

Declaration Signing | Media Outreach | MASLD/MASH Awareness in Bergamo | Become #MASHCities | The Initiative

Bergamo, Italy Kicks Off MASH Cities

On 13 February, Europe took a decisive step forward on urban liver health.
The first-ever Declaration on Ending the MASLD/MASH Public Health Threat in Cities was officially signed, with the Mayor of Bergamo, Italy serving as the inaugural signatory.

This Declaration—central to the MASH Cities initiative—formally recognises metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH) as local public health priorities. It commits cities to coordinated action across awareness, prevention, early identification, liver fibrosis assessment, and linkage to care. While non-binding, the Declaration is designed to catalyse sustained municipal leadership and accountability on a largely under-recognised metabolic condition that is rapidly increasing across Europe.

The signing was accompanied by a policy-focused session translating epidemiological and clinical evidence into practical entry points for city leaders. A city-level MASH awareness study is envisioned as a flagship activity to generate locally relevant data to inform policy and measure progress.

Read The Original Declaration (Italian)

Read The Declaration (English)

*This milestone was made possible through the leadership of CUNY SPH professor and ISGlobal Public Health Liver Group (PHLG) Head Jeffrey V. Lazarus, Postdoctoral Fellow Trenton M. White, PhD, who directly oversees the initiative, and the mentorship and partnership of Dr. Loreta Kondili at the Istituto Superiore di Sanità in Italy. The collaboration between Drs White and Kondilit was facilitated by the EASL | The Home of Hepatology Mentorship programme, which demonstrates how a clinical association can support meaningful policy change.

Declaration Signing

Media Outreach

MASLD/MASH Awareness in Bergamo

Coming soon!

Become #MASHCities

Interested in forming part of #MASHCities?

We’re building a growing network of cities committed to making liver health visible, local, and actionable.

If you work in city government, public health, or local policymaking, you can play a key role in integrating liver health into your city’s response to metabolic disease and health equity. Register your interest below to explore how your city can take part—and help shape solutions that reflect the realities of your communities.

MASH Cities is an initiative of the Global Think-tank on Steatotic Liver Disease

MASH Cities brings liver health into everyday life by anchoring it where change begins—in cities. Health agendas already focus on diabetes, obesity, and cardiovascular risk, but one organ often goes unnoticed: the liver. Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) affect millions worldwide, yet remain a missing piece in most city health strategies.

MASH Cities makes liver health visible, tangible, and actionable by convening city officials, community leaders, healthcare providers, and industry partners. Through data, stories, and connection, it acts as a catalyst for city-led action and cross-sector collaboration—showing that liver health can, and must, grow in every community.

To stay up-to-date with MASH Cities, follow the LinkedIn page

admin2026-04-08T15:31:31+00:00

Dichiarazione per l’eliminazione della minaccia alla salute pubblica rappresentata dalla MASLD nelle città
Città di Bergamo

Premessa
Noi, i sottoscritti rappresentanti del Comune di Bergamo, ci impegniamo ad affrontare la crescente sfida rappresentata dalla malattia epatica steatosica associata a disfunzione metabolica (MASLD) e dalla sua forma progressiva, la steatoepatite associata a disfunzione metabolica (MASH). Sebbene rappresenti la malattia epatica più comune a livello globale, la MASLD rimane largamente sconosciuta al pubblico, sottodiagnosticata dai sistemi sanitari e trascurata dalla maggior parte delle politiche di salute pubblica. In quanto Comune, riconosciamo la nostra responsabilità e la nostra capacità unica di migliorare le condizioni in cui le persone vivono, lavorano e crescono. Agiremo localmente attraverso la leadership civica e politica, con azioni coordinate tra i diversi settori comunali e con partenariati, per aumentare la consapevolezza, promuovere la prevenzione e integrare la salute epatica nell’agenda urbana della salute.

1. Riconoscere MASLD/MASH come minaccia per la salute pubblica
Riconosciamo MASLD e MASH come una minaccia di salute pubblica nell’ambito dell’agenda cittadina sulle malattie non trasmissibili, sull’equità nella salute e sulla vita urbana sostenibile. Integreremo la promozione della salute epatica nei programmi esistenti su obesità, diabete, salute cardiovascolare e stili di vita sani.

2. Aumentare la consapevolezza e migliorare l’alfabetizzazione sanitaria
Guideremo campagne informative locali per aumentare la consapevolezza pubblica e professionale su MASLD, i suoi fattori di rischio e i legami con altre condizioni metaboliche. Collaboreremo con scuole, luoghi di lavoro, organizzazioni comunitarie e media per promuovere messaggi inclusivi e privi di stigma che favoriscano la prevenzione e l’azione precoce.

3. Facilitare l’identificazione tempestiva e il collegamento alle cure
Collaboreremo con i servizi sanitari locali, i medici di medicina generale e i centri di salute comunitaria per promuovere la valutazione del rischio e la consapevolezza tra i professionisti sanitari, in particolare nelle cure primarie, nei centri per diabete, obesità e cardiologia. Il nostro ruolo sarà quello di favorire l’accesso a livello comunitario e i collegamenti tra le iniziative di promozione della salute comunali e le strutture sanitarie regionali.

4. Creare ambienti che favoriscano la salute epatica
Useremo le politiche municipali e gli strumenti di pianificazione urbana per creare ambienti che promuovano l’attività fisica, le diete sane e il benessere generale. Ciò include integrare obiettivi di salute nella progettazione urbana, nei trasporti e nelle politiche alimentari.

5. Rafforzare i dati locali e l’innovazione
Sosterremo la raccolta e la condivisione di dati locali relativi al rischio metabolico, all’obesità e alla salute epatica per guidare le politiche comunali. Incoraggeremo partenariati con istituti di ricerca, agenzie sanitarie e iniziative di innovazione.

6. Costruire partenariati intersettoriali e comunitari
Promuoveremo la collaborazione tra i diversi dipartimenti comunali e coinvolgeremo associazioni di pazienti, organizzazioni giovanili e migranti e ONG per co-progettare soluzioni.

7. Garantire equità e inclusione
Daremo priorità alle comunità che affrontano svantaggi sociali ed economici, assicurando che le iniziative di prevenzione e sensibilizzazione raggiungano chi è maggiormente a rischio.

8. Monitorare i progressi e mantenere la responsabilità pubblica
Definiremo obiettivi misurabili per le azioni locali legate a MASLD e revisioneremo i progressi annualmente come parte del report comunale su salute e benessere.

Allegato – Città di Bergamo
In linea con la Dichiarazione MASLD per le Città, il Comune di Bergamo e l’ASST Papa Giovanni XXIII si impegnano a realizzare le seguenti azioni specifiche:

Attività di prevenzione e sensibilizzazione. Il personale sanitario dell’ASST Papa Giovanni XXIII – Medici specialisti, Medici di Assistenza Primaria, Infermieri di Famiglia e di Comunità – svolge attività continuative di formazione, prevenzione e educazione sanitaria, in stretta collaborazione con i Medici di Assistenza Primaria e con gli Infermieri di Famiglia e di Comunità. Nel contesto nazionale e lombardo, si evidenzia una carenza di dati epidemiologici aggiornati sulla MASLD, che rende necessaria la definizione di criteri condivisi per la presa in carico e il referral dei pazienti, favorendo una gestione omogenea e integrata tra i diversi livelli assistenziali. Parallelamente, la promozione di iniziative di sensibilizzazione e informazione rivolte alla popolazione, da realizzarsi nelle Case di Comunità e in altri contesti aggregativi (scuole, università, centri civici, eventi pubblici), rappresenta uno strumento essenziale per la diffusione di corretti stili di vita e per un’efficace prevenzione della malattia.
Attività di prevenzione nei quartieri e nei comuni della provincia sull’alimentazione e sull’attività motoria. Professionisti competenti dell’ASST Papa Giovanni XXIII organizzano interventi educativi sul tema dell’alimentazione e dell’attività motoria in maniera capillare e prossima ai luoghi di vita della cittadinanza nel contesto del Laboratorio per la promozione di attività fisica e movimento costituito a livello aziendale.
Divulgazione scientifica attraverso i social media e canali locali. L’ASST Papa Giovanni XXIII mette a disposizione le proprie competenze scientifiche per la realizzazione di contenuti e di pubblicazioni sui temi di interesse, al fine di una prevenzione primaria e di una promozione dei corretti stili di vita.
Coinvolgimento degli studenti delle scuole superiori in campagne grafiche o mediatiche di sensibilizzazione e prevenzione. L’ASST Papa Giovanni XXIII mette a disposizione le proprie competenze relativamente ai contenuti e alle necessità comunicative rilevate nella popolazione.
Collaborazione con i medici di medicina generale per iniziative di prevenzione e diagnosi precoce. Nell’ottica di una costante integrazione ospedale-territorio, l’ASST Papa Giovanni XXIII ha attivato un percorso di formazione e di stesura di Percorsi Preventivo-Diagnostico-Terapeutico-Assistenziali specifici per patologia, al fine di consentire la prevenzione, l’intercettazione precoce e il management territoriale.
Coinvolgimento dell’associazionismo sulle patologie correlate (diabete, patologie cardiache, ecc.) È presente una stretta collaborazione tra istituzione sociosanitaria ed enti del terzo settore, nel contesto dell’integrazione sociosanitaria posta in essere per lo sviluppo delle Case di Comunità.

Firme:

Comune di Bergamo

ASST Papa Giovanni XXIII

La Dichiarazione per l’eliminazione della minaccia alla salute pubblica rappresentata dalla MASLD nelle città è stata prodotta da MASH Cities, un’iniziativa del Global Think-tank on Steatotic Liver Disease. MASH Cities è stata lanciata nel 2024 presso la CUNY Graduate School of Public Health and Health Policy di New York City.

Registration fees

All applications for registration will be reviewed, and you will be notified of your invitation status and fee via email within one week.

Category	Early Bird (before 1 April)	After / onsite
Private Sector/Industry	295	350
Start-up*	95	150
Healthcare Professional, Academic, Public Health/Professional Association, NGO	75	100
Young Researcher / Trainee / PostDoc / Student / Young Person (under 25) *	45	60
Patient with lived experience *	free	free
Patient or Patient Representative *	45	50

* Registration fee scholarship offered on application, please email: lisa.rice@isglobal.org

Criteria for start-ups:

Early-stage startup (e.g., pre-seed, seed, or Series A).
Incorporated for under 5 years
Raised under $5 million in funding
Annual revenue less than $1 million
Fewer than 50 employees

What’s included in your ticket?

Entry to lunch main agenda sessions 1pm-7pm on 26 May and evening reception

5. Strengthen the capacity of community health services to prevent and treat MASLD through social prescribing

Primary care has a well-established network of health centres across Spain. In the last years, there has been an increase in the number of community-based activities promoting well-being and reducing the metabolic risk profile through social prescribing. These activities usually integrate exercise through increasing physical activity.⁴⁵ Strengthened primary care systems can reinforce the role of community health services by incorporating social prescribing models to address lifestyle drivers of MASLD in vulnerable populations, such as physical activity, which is a recommended first-line therapy of people with MASLD, and can improve psychosocial health,⁴⁶ which is often reported as poor by people living with MASLD.⁴⁶ By facilitating participation in community-based activities like group exercise, arts, or wellness programs, social prescribing addresses both physical inactivity and the isolation or low mood commonly seen in this population.⁴⁷ In Catalonia, the Programa de Prescripció Social i Salut exemplifies this approach by linking patients to local community assets via an integrated system in primary care, particularly targeting conditions such as anxiety, depression, and social isolation,⁴⁴ and which may be beneficial for people living with MASLD/MASH. Elsewhere, social prescribing has demonstrated benefit for people living with diabetes.⁴⁸ Evaluation data from Catalonia show that over 70% of participants report improvements in emotional well-being and social support after engaging in prescribed community activities frequently related to physical activity.⁴⁴

5. Leverage electronic health records (EHR) through integrated automated diagnostic tools

Integrating MASLD/MASH screening algorithms into existing EHR systems can substantially enhance early detection and risk stratification in primary and secondary care. Automated tools such as intelligent liver function testing (iLFT)—which systematically interprets routine liver function tests, performs reflex testing, and identifies likely liver diseases for physicians to consider—have shown promise in improving early diagnosis and care pathways, particularly in underdiagnosed conditions like MASLD and MASH.⁴³ In the Spanish context, where nearly 10 million individuals may be living with MASLD by 2030,³ embedding such tools in the primary care EHR systems used across autonomous communities could standardise assessment, reduce diagnostic delays, and promote timely secondary referrals. Moreover, this approach complements digital transformation priorities already outlined in Spain’s National Health System and aligns with the objectives of the Strategic Framework for Primary and Community Care (2019).^26,44

4. Increase awareness and education of MASLD/MASH among at-risk groups and healthcare professionals

Enhancing awareness of MASLD/MASH among both at-risk populations—such as those living with obesity, diabetes, and metabolic syndrome—and frontline healthcare workers is critical for early identification, appropriate risk stratification and timely intervention. Given its silent clinical course, MASLD is often underdiagnosed until advanced stages, particularly in primary care settings where patients with obesity, diabetes, or metabolic syndrome are commonly managed.

Spain’s Strategic Framework for Primary and Community Care (2019) already emphasises chronic disease prevention, making it an ideal entry point for MASLD/MASH education.²⁶ Yet, existing knowledge gaps among primary care providers regarding liver disease etiology, progression, and appropriate screening necessitate awareness or education campaigns and professional training modules that build the knowledge and clinical skills needed to manage MASLD in frontline settings.^24,41 A cohesive and comprehensive educational strategy is essential and could begin with the integration of MASLD/MASH-specific content into undergraduate, specialty, and continuing medical education curricula to foster competency in metabolic hepatology across the care continuum. A national interdisciplinary training strategy could bring together professionals from family medicine, endocrinology, cardiology, nephrology, internal medicine, endoscopy, clinical nutrition, and hepatology to address MASLD/MASH as a complex, multisystemic disorder.

A comprehensive communication and engagement health literacy strategy should position MASLD/MASH as serious, progressive, and multisystemic conditions. This involves dismantling the minimising narrative of “fatty liver” and clearly linking MASLD to major outcomes such as cardiovascular, renal and metabolic disease. Such a campaign should incorporate the concept of MetALD, which captures the under-recognised harm of moderate alcohol use in people with MASLD. Establishing a national MASLD/MASH patient platform would also enable the co-design of care pathways, educational materials, public campaigns, and research priorities, ensuring patient-centered policy and practice.

Finally, it is critical to explicitly position MASLD within the cardio-renal-metabolic axis, evolving toward a CHRM model (cardiovascular-hepatic-renal-metabolic).⁴² This paradigm recognises the liver as a pivotal organ in systemic metabolic dysfunction. The CHRM paradigm reflects the shared pathophysiology and clinical trajectories of MASLD, T2DM, chronic kidney disease, and cardiovascular disease. Scientific societies and patient organisations in Spain must collectively support and disseminate this integrative model, aligning MASLD policy with broader strategies for non-communicable diseases.

3. Add MASLD/MASH as an indicator to the list of Key Health System Indicators

Despite the rising clinical, social, and economic burden of MASLD, this condition is not currently included among Spain’s Key Health System Indicators, which guide monitoring, evaluation, and resource distribution across the National Health System.14 Integrating MASLD/MASH as a formal indicator would recognise the disease as a strategic health priority by integrating it into the national health information system, guiding decision-making on screening, diagnosis, and care pathways. Failure to track this disease risks underestimating its long-term economic and public health impacts. Incorporation into the indicator framework aligns with Spain’s commitment to data-driven governance and would support benchmarking across autonomous communities. To support targeted local action on MASLD, tools at the autonomous community level should be developed to guide policy and programme implementation. A MASLD risk index, combining aggregated clinical data, social determinants of health, and population-level metrics, can help identify high-need areas and inform municipal-level screening strategies. In parallel, a MASLD Impact Score should be created to assess the effectiveness of local policies related to metabolic health, food regulation, healthy environments, early detection practices, and workforce training. This metric could be implemented through municipal initiatives such as the upcoming “Santander se mueve” health promotion program, set to launch in September 2025.

2. Create a national MASLD registry, cohort, or observatory

Establishing a national MASLD registry, cohort or observatory is a critical step toward advancing clinical management, research, and policy evaluation. A national registry would enable the systematic collection of epidemiological, clinical, and sociodemographic data, essential for monitoring disease prevalence and progression, identifying high-risk subgroups, and assessing territorial disparities in access to care. While the Epidemiological sTudy of Hepatic infectiONs (ETHON) cohort estimated that 1.33%% of the Spanish population from 2015-2020 had MASH with fibrosis (stage F2-F3), these findings are limited to participants from primary care centers in Madrid, Santander and Valencia.^12,39 Additionally, while national clinical registries like HEPAmet and REGHNA (focused on hospital settings) provide important data, they are not population-based, nor are they consistently linked with public health surveillance systems.⁴⁰ A standardised and centralised MASLD registry would enable longitudinal tracking of this more prevalent disease, facilitate research on progression and treatment outcomes, and help evaluate the impact of interventions over time. Furthermore, registry data could support regional health planning and inform clinical practice guidelines aligned with Spain’s digital health transformation efforts.

1. Launch a Ministry of Health-led whole-of-government strategy

The growing prevalence of MASLD and MASH in Spain—projected to affect over 27% and 5.9% of the population, respectively, by 2030—necessitates an integrated, cross-sectoral policy response,³ led by an intersectoral working group under the leadership of the Ministry of Health. This whole-of-government initiative could facilitate the mainstreaming of MASLD/MASH into key national strategies addressing chronic diseases in general, and obesity, diabetes, and cardiovascular health specifically through a “health in all policies” approach. These strategies include the Strategy for Addressing Chronic Diseases (2012),²⁷ the Diabetes Strategy (2006)²⁸ and its 2012 update²⁹, and the Cardiovascular Health Strategy (2022),³⁰ where MASLD/MASH remain largely underrepresented despite their metabolic underpinnings. This omission contributes to fragmented care and missed opportunities for early intervention. Systematic integration of MASLD across these strategies would allow Spain to align with recommendations from the EASL–Lancet Liver Commission, which urges countries to address liver diseases through upstream, equity-based, and multisectoral policies.³²

Crucially, national leadership must be paired with urban action. Cities are where obesogenic environments, food insecurity, and social inequalities converge with high diabetes and obesity prevalence. An initiative to address this, “MASH Cities,” calls on municipalities to integrate MASLD/MASH into local health promotion, food policy, urban mobility, and primary care services to mitigate disease progression.³³ Major cities in Spain should consider joining this growing platform for sharing learned lessons and best practices. Empowering cities with the mandate and resources to act on liver health can serve as a scalable, equitable response to this growing challenge, as was proposed for Barcelona in May 2025.³⁴

Additionally, inclusion of MASLD/MASH in Spain’s Public Health Surveillance Strategy (2022)³⁵ could strengthen early detection and monitoring by enabling systematic data collection and risk assessment in both health and non-health sectors, such as urban planning and food policy. Primary care would be central to this approach, serving as the frontline for MASLD screening, risk stratification, and referral. Integration can help standardise primary care practices, including routine FIB-4 risk stratification of individuals with obesity, T2D, metabolic syndrome, or hepatic steatosis—which are often undetected until advanced stages.³⁶ Primary care should be adequately funded and equipped to screen, stratify, manage cardiometabolic risks, and refer high-risk patients, forming the backbone of MASLD/MASH prevention and control at the national, autonomous community, and city levels.^37,38

Registration fees

Category	Early Bird (before 1 April)	On-site
Private Sector/Industry	495	695
Start-up*	150	200
Healthcare Professional, Academic, Public Health/Professional Association, NGO	100	150
Young Researcher / Trainee / PostDoc / Student / Young Person (under 25) *	50	50
Patient or Patient Representative *	50	50

* Registration fee scholarship offered on application, please email: lisa.rice@isglobal.org

Criteria for start-ups:

Early-stage start-up (e.g., pre-seed, seed, or Series A) / Incorporated for under 5 years

Raised under $5 million in funding / Annual revenue less than $1 million

Fewer than 50 employees

What’s included in your ticket?

Entry to all main agenda sessions starting 2pm on 5 June

5 June: Lunch and afternoon networking coffee, and networking buffet reception

6 June: Morning and afternoon networking coffee, and networking lunch

The City of Bergamo Kicks Off MASH Cities

Bergamo, Italy Kicks Off MASH Cities

On 13 February, Europe took a decisive step forward on urban liver health.
The first-ever Declaration on Ending the MASLD/MASH Public Health Threat in Cities was officially signed, with the Mayor of Bergamo, Italy serving as the inaugural signatory.

Declaration Signing

Media Outreach

MASLD/MASH Awareness in Bergamo

Become #MASHCities

Interested in forming part of #MASHCities?

MASH Cities is an initiative of the Global Think-tank on Steatotic Liver Disease

Registration fees

All applications for registration will be reviewed, and you will be notified of your invitation status and fee via email within one week.

Criteria for start-ups:

What’s included in your ticket?

5. Strengthen the capacity of community health services to prevent and treat MASLD through social prescribing

5. Leverage electronic health records (EHR) through integrated automated diagnostic tools

4. Increase awareness and education of MASLD/MASH among at-risk groups and healthcare professionals

3. Add MASLD/MASH as an indicator to the list of Key Health System Indicators

2. Create a national MASLD registry, cohort, or observatory

1. Launch a Ministry of Health-led whole-of-government strategy

References

What is ALD?

What is MetALD?

What is MASLD?

What is steatotic liver disease?

Further reading

Registration fees

Criteria for start-ups:

What’s included in your ticket?

Agenda

5 June 2025

6 June 2025

*CARPA

The City of Bergamo Kicks Off MASH Cities

Bergamo, Italy Kicks Off MASH Cities

On 13 February, Europe took a decisive step forward on urban liver health. The first-ever Declaration on Ending the MASLD/MASH Public Health Threat in Cities was officially signed, with the Mayor of Bergamo, Italy serving as the inaugural signatory.

Declaration Signing

Media Outreach

MASLD/MASH Awareness in Bergamo

Become #MASHCities

Interested in forming part of #MASHCities?

MASH Cities is an initiative of the Global Think-tank on Steatotic Liver Disease

Registration fees

All applications for registration will be reviewed, and you will be notified of your invitation status and fee via email within one week.

Criteria for start-ups:

What’s included in your ticket?

5. Strengthen the capacity of community health services to prevent and treat MASLD through social prescribing

5. Leverage electronic health records (EHR) through integrated automated diagnostic tools

4. Increase awareness and education of MASLD/MASH among at-risk groups and healthcare professionals

3. Add MASLD/MASH as an indicator to the list of Key Health System Indicators

2. Create a national MASLD registry, cohort, or observatory

1. Launch a Ministry of Health-led whole-of-government strategy

References

What is ALD?

What is MetALD?

What is MASLD?

What is steatotic liver disease?

Further reading

Registration fees

Criteria for start-ups:

What’s included in your ticket?

Agenda

5 June 2025

6 June 2025

*CARPA

On 13 February, Europe took a decisive step forward on urban liver health.
The first-ever Declaration on Ending the MASLD/MASH Public Health Threat in Cities was officially signed, with the Mayor of Bergamo, Italy serving as the inaugural signatory.