Explore curated tools designed to make liver disease easier to understand—from the science and lived experiences to the systems shaping care and policy. This section brings together plain-language explainers, research breakdowns, and definitions of key terms to help you connect the dots between liver health and the bigger picture.
Why liver health matters
A look at liver disease within the global health landscape
The liver is one of the most critical and incredible organs in the human body, located in the upper right part of the abdomen. It acts like the body’s chemical factory, helping to regulate the levels of nutrients we obtain from our food. It also helps filter toxins. But in some situations–like having obesity, insulin resistance, or regularly eating too much sugar or drinking too much alcohol–fat can start accumulating in the liver and begin to affect proper liver functioning.
When more than 5% of the liver’s cells (hepatocytes) have fat in them, it’s considered a steatotic liver—what used to be called “fatty liver.” Today, this condition is known as Steatotic Liver Disease, or SLD.
SLD is a spectrum of a disease driven by two leading risk factors: alcohol consumption and metabolic conditions (such as obesity, type 2 diabetes) that disrupt the body’s ability to turn food into energy. The amount of each risk factor and the combination between them determines the exact disease’s definition:
The liver is not meant to store fat. As fat accumulates, it triggers an inflammatory response. This can harm liver cells. Over time, if there’s no treatment, SLD might worsen and reach an inflammatory phase of the disease called metabolic dysfunction-associated steatohepatitis (MASH). This form is more severe and could cause liver scarring (fibrosis), cirrhosis (severe liver damage), or even liver cancer. It’s also a risk factor for heart disease.
The good news is that making lifestyle changes—such as following Mediterranean or plant-based dietary patterns, staying active, losing weight if needed, and avoiding alcohol—can not only stop liver disease from getting worse but also help improve liver health.
Key terms & concepts
Definitions, stories, and calls to action
Obesity is one of the strongest drivers of metabolic dysfunction-associated steatotic liver disease (MASLD).
Excess body fat, particularly visceral fat, promotes the accumulation of fat in the liver (hepatic steatosis) and raises the likelihood of progression to liver inflammation (MASH) and fibrosis. MASLD should be understood as the hepatic component of a broader metabolic disease continuum, not an isolated liver condition. Assessing metabolic risk requires looking beyond BMI: measures of central adiposity, such as waist circumference and waist-to-height ratio, are more meaningful guides to individual risk.
Current European guidance recognise the high prevalence of MASLD among people with obesity and type 2 diabetes, which makes them “indicator conditions,” a high priority for case-finding and timely intervention.
Carlos is a 48-year-old logistics manager in Guadalajara. He was referred to an endocrinologist after years of poorly controlled type 2 diabetes and rising triglycerides. His weight had been a recurring conversation, but always in the context of blood sugar and cardiovascular risk. His liver had never come up during visits with his healthcare provider.
After reporting abdominal pain, an ultrasound revealed significant hepatic steatosis. Carlos was referred to a hepatologist and diagnosed with MASLD. “I knew my metabolism was the problem,” he said. “I just didn’t know my liver was part of it.”
His endocrinologist reframed his care plan entirely. Managing his visceral fat was not a matter of appearance or even heart health alone…it was driving disease across multiple organs at once.
Health systems should support integrated care pathways that address obesity and MASLD together, rather than as separate conditions managed in separate clinical silos. Obesity management programmes should include routine liver fibrosis assessment, and hepatology services should systematically screen for and address excess adiposity. Central adiposity measures, including waist circumference and waist-to-height ratio, should be incorporated into national screening protocols alongside BMI.
- Pugliese et al. Diagnostic innovation and models of care to improve fibrosis detection and risk stratification in steatotic liver disease.
- Tacke et al. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD)
- Pekarska et al. Nutrition in MASLD: a patient focused, evidence-based clinician’s guide.
- Rubino et al. Definition and diagnostic criteria of clinical obesity.
- Obesity and liver health: two sides of the same coin (A joint post by World Obesity Federation and ISGlobal Public Health Liver Group)
MASLD may occur in people whose body mass index (BMI) falls within the normal range.
Often labelled “lean MASLD”, this term is increasingly seen as misleading: a normal BMI does not rule out visceral adiposity (abnormally deposited fat around organs), insulin resistance, or liver disease. BMI is a blunt instrument: useful at the population level, but a poor measure of individual metabolic risk.
Importantly, it is not total body weight, but rather, the amount and distribution of body fat: two people with the same BMI can carry very different burdens of visceral adiposity, and it is this hidden fat that drives metabolic dysfunction and liver disease. In South Asian and East Asian populations, in particular, significant metabolic risk can be present at BMI levels considered normal under standard “Western” classifications, which makes ethnicity-specific thresholds essential.
Ananya is a 41-year-old schoolteacher in Chennai. At a check-up, her doctor noted that her BMI was 22 — well within the healthy range and suggested no further investigation was needed. Two years later, a routine blood test flagged elevated liver enzymes and an ultrasound showed hepatic steatosis.
She was surprised. She wasn’t overweight. But waist circumference measurement revealed visceral adiposity and further tests showed insulin resistance, neither of which were visible on the scale. Ananya had MASLD. “I thought being thin meant being healthy,” she said. “No one told me my liver could be struggling”.
Screening for MASLD must assess adiposity, not BMI alone.
Clinical practice guidelines should recommend that BMI no longer be used as a standalone criterion for MASLD, replacing it with metabolic risk-based assessment that directly measures body fat, for example through waist circumference, alongside impaired glucose metabolism and other markers of metabolic dysfunction. For South Asian and East Asian populations, lower BMI and waist-circumference thresholds are already recommended and can be found in clinical practice guidelines; the priority now is to apply them consistently and embed them in MASLD screening protocols.
- Stefan et al. Metabolic dysfunction-associated steatotic liver disease: heterogeneous pathomechanisms and effectiveness of metabolism-based treatment.
- Long et al. AGA Clinical Practice Update: Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Lean Individuals: Expert Review.
- Pekarska et al. Nutrition in MASLD: a patient focused, evidence-based clinician’s guide.
- Rubino et al. Definition and diagnostic criteria of clinical obesity.
Differences in the prevalence and access to treatment and care and outcomes of liver diseases, often driven by socio-economic, racial, or geographic inequities.
Policy-makers should expand telemedicine and incentivise metabolic community health services in underserved areas. Medical societies should advocate for liver screening programmes in primary care settings and the community.
- Kardashian et al. Health disparities in chronic liver disease.
- Talens et al. What Do We Know about Inequalities in NAFLD Distribution and Outcomes? A Scoping Review.
- Kondili et al. Inequities in primary liver cancer in Europe: The state of play.
Conditions like income, education, housing, food access, and social support that shape liver disease risks and outcomes.
Marcus, a 39-year-old high-tech worker, working long hours and living with hepatitis B, eats little fresh food. Instead, his diet consists mainly of processed meals high in sugar and fat, contributing to his MASLD diagnosis.
Create culturally sensitive, workplace and community-based liver health programs that address food access and health literacy for all.
Proven, cost-effective interventions for liver disease, such as routine screening for liver fibrosis in people living with type 2 diabetes (T2D) or obesity.
Sofia, a 49-year-old woman with type 2 diabetes, was offered a simple blood-based liver fibrosis test during her routine diabetes check-up. The test identified early signs of liver damage, even though she had no symptoms. With tailored counselling and lifestyle support, she changed her diet, lost some weight, and avoided disease progression. Her care team credits the screening for catching MASLD before it turned into something more serious.
National health systems should integrate liver fibrosis screening into type 2 diabetes and obesity clinical care guidelines. Payers and providers must invest in scalable tools like non-invasive tests and digital risk assessments to identify liver disease early and act decisively.
- Lindfors et al. Screening for advanced liver fibrosis due to metabolic dysfunction-associated steatotic liver disease alongside retina scanning in people with type 2 diabetes: a cross-sectional study.
- Galea et al. Quick buys for prevention and control of noncommunicable diseases.
- Lazarus, Jeffrey V et al. Best buy interventions to address the burden of steatotic liver disease.
Migrant populations often face challenges that non-migrant populations do not, such as liver disease risk factors and barriers to liver care and treatment that result in higher burdens of liver disease.
Baye, a 45-year-old refugee, acquired hepatitis B from his mother during birth and did not receive appropriate preventive measures like the HBV birth dose vaccine to potentially stop onward transmission. He has been living with HBV since he was born but did not know it. He recently accessed care through a community clinic, but cirrhosis due to HBV and MASH has limited his options. Early intervention could have saved his liver and improved his quality of life.
Provide targeted outreach programmes to ensure migrants and refugees are screened and vaccinated for hepatitis B and receive education about the importance of reducing metabolic risk for developing steatotic liver disease and limiting alcohol consumption.
A proactive approach to liver disease that emphasises early detection, lifestyle interventions, vaccination, and policies that prevent disease incidence and progression.
Leah, a 35-year-old office worker discovered she had MASLD during a routine check-up. With dietary changes and physical activity, she reversed her condition and avoided more serious liver complications.
Healthcare professionals should incorporate routine MASLD screenings into annual health checks and assess alcohol and ultra-processed consumption of their patients, while policy-makers invest in public awareness campaigns on liver health.
- Ivancovsky-Wajcman et al. Integrating social nutrition principles into the treatment of steatotic liver disease.
- Ivancovsky-Wajcman et al. Prioritising viral hepatitis elimination to prevent hepatocellular carcinoma: A public health approach for effective preventive hepatology.
- Hirschfield et al. Preventative hepatology: minimising symptoms and optimising care.
Self-reported measures that capture patients’ perspectives on the impact of liver disease on their daily lives, well-being, and treatment satisfaction that can help guide clinical decision making.
James, a 56-year-old living with MASLD, felt dismissed by his care team when he reported severe fatigue and emotional distress. Once his physician implemented a PRO questionnaire, James felt heard, and his treatment plan was adjusted to address his holistic needs.
Incorporate PRO tools in clinical settings to ensure patient voices guide treatment decisions and improve outcomes.
- Barberá et al. Patient-Reported Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease.
- Younossi et al. The impact of stigma on quality of life and liver disease burden among patients with nonalcoholic fatty liver disease.
- Carol et al. Stigmatization is common in patients with non-alcoholic fatty liver disease and correlates with quality of life.
The recognition of metabolic dysfunction-associated steatotic liver disease as a leading cause of liver-related morbidity and mortality worldwide.
Priya, a 35-year-old office worker, was shocked when diagnosed with MASLD despite not feeling sick. Her physician explained that MASLD is common and preventable but often undiagnosed. With lifestyle changes enabled by nearby fresh food markets, Priya now advocates for better awareness and food systems.
Policymakers should integrate SLD prevention into national health campaigns, for example, promote alcohol zero target, and physicians should screen at-risk patients systematically, including alcohol consumption evaluation.
Coordinated healthcare approaches that connect hepatology with primary care, endocrinology/diabetology, nutrition, and mental health to improve liver disease management and outcomes.
Alan, a 62-year-old with diabetes, hypertension, and MASLD, was overwhelmed managing multiple specialists. A multidisciplinary care team, that also considers the patient’s needs and preference, simplified his care, addressing his liver disease while managing his other conditions.
Develop and fund integrated care models for SLD and metabolic comorbidities to improve patient outcomes and reduce healthcare costs.
- Schattenberg et al. A multistakeholder approach to innovations in NAFLD care.
- Kumar et al. Multidisciplinary Clinic Models: A Paradigm of Care for Management of NAFLD.
- Srivastava et al. Prospective evaluation of a primary care referral pathway for patients with non-alcoholic fatty liver disease.
- Allen et al. Measuring NAFLD models of care.
- Lazarus et al. Defining comprehensive models of care for NAFLD.
The negative social attitudes and discrimination faced by individuals with liver conditions, particularly those linked to alcohol use, viral hepatitis, or obesity, which can impact healthcare access and mental well-being.
John, a 50-year-old construction worker, hid his MASLD diagnosis due to the stigma of “lifestyle diseases.” He delayed seeking care, which worsened his condition. A supportive group helped him accept his diagnosis and follow a treatment plan.
Launch campaigns that normalize liver disease as a medical condition rather than a moral failing to encourage earlier care-seeking.
- Karlsen et al. The EASL–Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality.
- Harris et al. Conceptualising hepatitis C stigma: A thematic synthesis of qualitative research.
- Younossi et al. Global survey of stigma among physicians and patients with nonalcoholic fatty liver disease.
- Marinho et al. Hepatitis C, stigma and cure.
- Carol et al. Stigmatization is common in patients with non-alcoholic fatty liver disease and correlates with quality of life.
The intersection of dietary habits, food environments, and social policies that emphasize access to affordable, healthy foods and reduce dietary risks for liver disease.
Asha, a 44-year-old single mother, struggled to provide healthy meals for her family on a limited budget. After joining a social nutrition program at her local clinic, she learned how to prepare liver-friendly meals on a budget.
- Ivancovsky-Wajcman, et al. Integrating social nutrition principles into the treatment of steatotic liver disease.
- Hardcastle, et al. Food Choice and Nutrition: A Social Psychological Perspective.
Technology-driven solutions, such as telemedicine, mobile apps, and AI-based diagnostics, that enhance liver disease prevention, monitoring, and patient engagement.
Ben, a 47-year-old truck driver, used a mobile app to track his liver function and diet. The app reminded him to get regular check-ups and helped him stick to his treatment plan.
- Lazarus et al. Physicians’ Use of Digital Health Interventions in the Management of Nonalcoholic Fatty Liver Disease.
- Ratziu et al. Artificial intelligence-assisted digital pathology for non-alcoholic steatohepatitis: current status and future directions.
- Chakrabarti et al. Smart Consumer Wearables as Digital Diagnostic Tools: A Review.
- Kopka et al. We must address the MASLD awareness gap, improve educational quality and prepare for the digitally quantified self.
The pursuit of fair and just access to liver disease prevention, diagnosis, and treatment worldwide, addressing disparities between high- and low-income settings.
Fatima, a 62-year-old grandmother in a low-income country, had no access to hepatitis B vaccination as a child. Today, her grandchildren benefit from WHO vaccination programs, breaking the cycle of liver disease in her family.
- Ventura-Cots et al. Applying an equity lens to liver health and research in Europe.
- Kondili et al. Inequities in primary liver cancer in Europe: The state of play.
- Lazarus et al. The global NAFLD policy review and preparedness index: Are countries ready to address this silent public health challenge?
The impact of pollutants, toxins, and occupational hazards on liver function, including the role of air pollution, industrial chemicals, and endocrine disruptors in liver disease development.
Ravi, a 50-year-old factory worker, was exposed to industrial chemicals that contributed to liver damage. Advocacy by his local union led to workplace safety reforms, improving conditions for future workers.
Enforce stronger regulations on environmental toxins and workplace safety to protect liver health.
- Barouki et al. The exposome and liver disease – how environmental factors affect liver health.
- Sen et al. Exposure to environmental contaminants is associated with altered hepatic lipid metabolism in non-alcoholic fatty liver disease.
- Lin et al. Environmental exposure to cooking oil fumes and fatty liver disease.
Strategies to reduce the risk of hepatocellular carcinoma (HCC), including hepatitis B vaccination, hepatitis C treatment, alcohol reduction, obesity prevention, and early screening for high-risk individuals.
Olivia, a 58-year-old with advanced MASLD, called MASH, and liver cirrhosis, joined a preventive screening program that detected liver abnormalities early. She received treatment before developing liver cancer.
Policymakers must fund early detection programs and mandate MASLD/MASH screening for high-risk populations.
The role of industries (e.g., ultra-processed foods, alcohol, sugar, tobacco) in shaping liver disease risk through marketing, pricing, and policy influence.
- WHO. Commercial determinants of health.
- Tapper et al. Attacking Alcohol-Related Liver Disease by Taxing Alcohol Sales.
- Ivancovsky-Wajcman et al. Integrating social nutrition principles into the treatment of steatotic liver disease.
Breaking down the science
Easy-to-follow summaries of key research
Global Metabolic & Liver Health Policy
Global Metabolic & Liver Health Policy
Lazarus, Jeffrey V. et al.
Journal of Hepatology, Volume 79, Issue 3, 618 - 634
