From the Scientific Literature
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Prevention, early detection, and treatment of liver diseases should be more focused in primary care, urges an expert commission. Only this way can the global rise of these diseases be stopped.
Every year, around 2 million people die from liver diseases worldwide, and this number is rising. However, prevention, early detection, and long-term care of liver diseases have hardly been integrated into primary care. An expert commission led by Dr. Helen Jarvis from Newcastle University calls for a paradigm shift: General practitioners should play a central role in managing chronic liver diseases.
1.3 Billion Affected: MASLD on the Rise
The most common chronic liver disease is metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD). An estimated 1.3 billion people were affected in 2023, and this number could rise to 1.8 billion by 2050, according to Dr. Jarvis and her team. Concurrently, alcohol-related liver disease (ALD) is also increasing in many countries. Both conditions can progress to fibrosis, cirrhosis, and ultimately liver cancer.
Liver diseases disproportionately affect socially disadvantaged individuals. This pattern is consistent across all etiologies, notes Dr. Jarvis et al. This is particularly pronounced in ALD: Although the extent of alcohol consumption is similar in low-income and high-income groups, alcohol-induced damage is significantly more frequent among the economically disadvantaged. In England, individuals from the lowest fifth of the population had more than three times the incidence of ALD compared to those from the wealthiest fifth between 2001 and 2018.
Targeted Fibrosis Tests Instead of Routine Liver Values
Chronic viral hepatitis poses another serious problem. Every day, approximately 4,900 people are newly infected with either the Hepatitis B or Hepatitis C virus globally. Highly vulnerable groups include injecting drug users, prisoners, sex workers, and men who have sex with men. According to the WHO, by the end of 2024, only 27% of HBV-infected individuals were appropriately diagnosed, and just 4.3% received antiviral therapy. For HCV, the figures were 36% and 20%, respectively.
A fatty liver is defined when at least 5% of hepatocytes contain lipid droplets. Ultrasound typically detects steatosis at about 20% fat content, and CT scans require 30%. Since histology and MRI are not universally available, the commission recommends a proactive, risk-based approach: Non-invasive fibrosis tests (e.g., FIB-4 as a first-line test) should be used in cases with risk factors. Routine liver values alone are not sufficiently sensitive for fibrosis diagnosis.
Fatty Liver Check: Key Risk Factors
Chronic kidney disease
Polycystic ovary syndrome
Family history of liver cancer or cirrhosis
Steatogenic medications (e.g., steroid hormones, sodium valproate)
Central to primary care should be: Alcohol screening (using the AUDIT* or AUDIT-C** questionnaires) followed by fibrosis diagnostics in positive cases, psychosocial and pharmacological interventions for alcohol abuse, dietary and exercise counseling, and developing individually tailored measures collaboratively with patients.
Even normal-weight individuals can develop MASLD, often with increased visceral fat and reduced muscle mass. These patients also benefit from exercise and moderate weight loss. In cases of viral hepatitis, identifying at-risk groups, checking HBV tests and vaccination status, and treating HCV infections early are crucial.
Integrating Liver Diagnostics into Routine Practices
General practitioners often do not see the management of liver diseases as part of their routine tasks. This situation is attributed to a persistent lack of time, inadequate reimbursement structures, insufficient training, and lack of resources.
Therefore, the expert commission calls for clear care pathways and better integration of liver health into existing care programs for chronic diseases like diabetes, hypertension, and obesity. It is essential to avoid overburdening primary care providers. Instead, liver diagnostics should be integrated into already established routines, supported by digital tools and AI-driven automation, especially in the analysis of non-invasive fibrosis tests. Political measures are required to finance this infrastructure.
* Alcohol Use Disorders Identification Test
** Alcohol Use Disorder Identification Test for Consumption
1. Jarvis H et al. Lancet Gastroenterol Hepatol 2026; doi: 10.1016/S2468-1253(26)00015-4
2. Brierley R, Thomas H. Lancet Gastroenterol Hepatol 2026; doi: 10.1016/S2468-1253(26)00196-2
Dr. Vera Seifert
Dr. Vera Seifert is a licensed physician with experience in the medical field (pediatric clinics and practices of general practitioners). Since 2024, she has been working as a freelance author.
