Briefing note

Chronic Liver Disease, MASLD/MASH, and the Global NCD Agenda

The UN General Assembly High-Level Meeting (HLM) on the Prevention and Control of Noncommunicable Diseases (NCDs), in September 2025, is a critical global forum where world leaders, policymakers, and health experts will convene to address the growing burden of NCDs—which for now only recognises cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, and mental illness as the leading cause of death, morbidity and disability globally. The HLM aims to strengthen political commitments, mobilise resources, and advance policies that promote prevention, early detection, and equitable access to treatment to reduce the health, economic and social impacts of NCDs. This important meeting fosters international collaboration to set the global political and policy agendas that address NCDs, ultimately contributing to the achievement of the Sustainable Development Goals (SDGs).

The high, rising burden of MASLD/MASH poses a public health threat that must be addressed within the broader NCD agenda, including the UN High-Level Meeting in 2025. Integrating liver disease prevention and management into existing NCD frameworks will improve global health outcomes, reduce healthcare costs, and advance equity in liver health.

Key Messages

Chronic liver disease (CLD) is a major but under-recognised NCD. It affects over 1.5 billion people worldwide and is a leading cause of morbidity and mortality, yet it remains absent from global NCD strategies and action plans.

Metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD) is the most common cause of CLD. MASLD affects an estimated 38% of the global population and is closely linked to obesity, type 2 diabetes, and other metabolic risk factors. MASLD is often regarded as a causal mechanism underlying the development of associated comorbidities, such as cardiovascular disease.

Metabolic dysfunction-associated steatohepatitis (MASH) is a silent epidemic, contributing to the metabolic syndemic of MASLD, obesity, type 2 diabetes and cardiovascular disease. Up to 30% of MASLD cases progress to MASH, the aggressive form of the disease, which increases the risk of cirrhosis, liver cancer, and liver-related deaths as well as extra-hepatic conditions.

Early detection and integration into NCD frameworks are critical. Simple, cost-effective screening tools exist but are underutilised. Primary healthcare systems must be equipped to identify and manage MASLD/MASH alongside diabetes, cardiovascular disease, and obesity.

Addressing MASLD/MASH aligns with global health equity goals. The disease disproportionately affects low- and middle-income countries, in terms of total numbers, and vulnerable populations, exacerbating existing health inequalities.

Cost-effective policy options, known as Best Buys and Quick Buys should be implemented by policy-makers to address all major NCDs, including MASLD/MASH.

Chronic Liver Disease and the NCD Agenda

Although a leading cause of death worldwide, liver diseases—including MASLD/MASH, viral hepatitis, and alcohol-related liver disease—have been largely overlooked in global NCD policies. MASLD, in particular, is strongly linked to other priority NCDs but lacks formal recognition in international health initiatives.

  • Liver disease is the 12th leading cause of death worldwide, yet prevention and early detection remain inadequate.
  • Liver cancer cases have tripled in the last three decades, with MASLD/MASH emerging as a major driver.
  • The global burden of MASLD is predicted to increase by 2030 by 21%; metabolic dysfunction-associated steatohepatitis by 63%; decompensated cirrhosis by 168%; and liver-related deaths by 178%
  • CLD disproportionately affects populations in Asia, Latin America, and Africa, where access to care is limited.

  • The metabolic connection: MASLD is closely tied to diabetes (affecting 70% of people with type 2 diabetes), obesity, and cardiovascular disease.
  • Silent but deadly: Most people with MASLD/MASH are undiagnosed, leading to preventable progression to cirrhosis and liver cancer.
  • Economic impact: MASLD-related healthcare costs exceed $100 billion annually in the U.S. and Europe alone.
  • A global equity issue: The highest burden of advanced liver disease and liver cancer, in terms of absolute numbers, due to MASLD is shifting to low- and middle-income countries.

Policy Recommendations

  1. Recognise chronic liver disease, including MASLD/MASH, as a priority NCD in global and national health strategies on par with cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, and mental illness.
  2. Integrate liver health screening into primary care for populations at risk, particularly people living with diabetes, obesity, and metabolic syndrome.
  3. Promote public health strategies targeting obesity, such as unhealthy diets, and sedentary lifestyles, to prevent and treat MASLD/MASH.
  4. Invest in research and epidemiologic surveillance of MASLD/MASH to inform evidence-based policy responses.
  5. Leverage international funding and partnerships to scale up liver health programmes in low-resource settings.

We support the NCD Alliance priorities for the 4th UN HLM on NCDs Political Declaration

ACCELERATE IMPLEMENTATION

Fast-track national implementation of evidence-based NCD policy recommendations to achieve progress on health and well-being for all, focusing first on those left furthest behind.

BREAK DOWN SILOS

Bring NCDs to the centre of global health and development agendas to consolidate efforts and achieve more through integrated action.

MOBILISE INVESTMENT

Provide sustainable financing for NCD across the full continuum of care that is sufficient to match the disease burden.

DELIVER ACCOUNTABILITY

Track, measure and fulfil commitments on NCD prevention and care in the lead-up to 2025, 2030 and beyond.

ENGAGE COMMUNITIES

Put people at the heart of the NCD response, supporting civil society, communities and people living with NCDs to be advocates, engage with policy makers, and occupy key decision-making roles.

and further call on UN member states to:

COMMIT TO:

including MASLD/MASH in NCD strategies, action plans and normative guidance.

SUPPORT:

policies that prioritise early detection and integrated care models.

ENSURE:

that liver health, including MASLD/MASH, as well as obesity, is recognised in future UNGA HLM declarations on NCDs.