The scientific conference “Innovation and Equity in Addressing Metabolic Dysfunction-Associated Fatty Liver Disease: A Commitment to People Living with Obesity,” held today at the headquarters of the Spanish Medical Association (OMC) on the occasion of World Obesity Day, concluded with the approval of the Madrid Declaration on Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD), a document that proposes a structural transformation in the healthcare response to this condition.
During the meeting, Javier Crespo, head of the event’s scientific leadership, scientific director of the Cantabria Cohort promoted by the Valdecilla Research Institute (IDIVAL), professor at the University of Cantabria, and member of the MedicineAI Association, explained that metabolic dysfunction-associated fatty liver disease must be placed at the center of the healthcare agenda due to its high prevalence—around 30% of the adult population—and its role as an early indicator of future cardio-hepato-renal-metabolic burden. He emphasized that the main problem is not the lack of scientific evidence, but rather the gap between knowledge and implementation, as well as organizational inertia that prevents the activation of structured and measurable responses.
In this regard, he advocated for integrating MAFLD into national non-communicable disease strategies with specific objectives and budgets, developing care models based on systematic fibrosis risk stratification, and addressing the social and commercial determinants of health by incorporating equity as a structural principle. In his view, without implementation, evidence loses value, and diagnosis must become an organizational and political decision accompanied by evaluation and accountability.
Madrid Declaration on MAFLD
The conference concluded with the approval of the Madrid Declaration on Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD), a strategic document proposing a structural transformation in the approach to this disease, currently the most prevalent chronic liver disease worldwide.
More than 30% of the adult population lives with MAFLD, a condition that is not an isolated liver disorder but rather the organ-specific expression of systemic metabolic dysfunction associated with increased cardiovascular, renal, and oncological risk. In this sense, it represents an early marker of metabolic vulnerability and a strategic opportunity to intervene before irreversible damage becomes established.
The Declaration calls for moving from a reactive and fragmented model toward a proactive, coordinated, and person-centered approach, closing the existing gap between scientific knowledge and effective implementation.
Among its strategic pillars are:
• Recognizing MAFLD as a priority within non-communicable diseases.
• Integrating systematic risk identification and stratification into routine clinical practice.
• Prioritizing early intervention with a comprehensive, value-based approach.
• Promoting coordinated care models across levels and specialties.
• Incorporating equity as a structural principle in detection, access, and intervention.
• Ensuring clear metrics, continuous evaluation, and accountability.
A ten-point plan for innovation and equity
The Declaration is structured around a ten-point plan that establishes concrete commitments to transform the healthcare response to MAFLD:
1. Recognize MAFLD as a strategic public health priority.
2. Consider it a marker of systemic metabolic risk.
3. Close the gap between scientific evidence and real-world implementation.
4. Prioritize early detection and structured risk stratification.
5. Orient clinical practice toward clinically relevant outcomes.
6. Incorporate equity as a structural principle in guidelines and policies.
7. Promote integrated and coordinated care models.
8. Turn diagnosis into structured clinical action.
9. Promote intersectoral policies consistent with metabolic prevention.
10. Ensure evaluation, transparency, and continuous improvement.
