New Global Study Identifies Best Buy Interventions to Integrate Liver Health into NCD Strategies

A new international study published in The Lancet Gastroenterology & Hepatology presents the first global expert consensus on which interventions to prioritise to prevent and manage metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH). The research proposes key evidence-based and cost-effective interventions for aligning liver health strategies with existing approaches to non-communicable diseases (NCDs), calling for their immediate integration into global health agendas.

MASLD, formerly known as non-alcoholic fatty liver disease (NAFLD), is estimated to affect more than a third of the global adult population. MASH, its more severe form, is a leading cause of cirrhosis, hepatocellular carcinoma (the most common type of liver cancer), liver transplantation, and liver-related mortality. Despite its scale and close link to obesity and type 2 diabetes (T2D), liver health has historically received limited policy attention compared to other major NCDs (e.g., obesity, T2D, cardiovascular disease and cancer). This study, coordinated by an international consortium of clinicians, researchers and public health experts, seeks to close that gap by identifying best buys, a concept introduced by the World Health Organization (WHO) to guide evidence-based and cost-effective interventions, to reduce the NCD burden.

A structured process to prioritise action

Researchers applied a modified Delphi process involving a diverse panel of 321 experts in hepatology, public health, primary care, nutrition, endocrinology, gastroenterology, and policy, from 85 countries. Participants assessed 15 interventions spanning education, clinical management, prevention, health system strengthening, and policy. The published evidence was reviewed and summarised for each proposed potential best buy. Furthermore, the best buys were examined to assess whether they could be classified as quick buys, defined as evidence-based and cost-effective measures that yield measurable public health impact within a five-year span.

The result was a strong global consensus. All 15 best buys met the criteria for prioritisation, although experts ranked some as particularly urgent. These include managing overweight, obesity, and T2Ds in people living with MASLD, promoting awareness among health-care providers and patients, liver fibrosis screening, and integration of care, involving various health-care professionals. “Routine screening for liver fibrosis in people living with type 2 diabetes” was the most endorsed quick buy (88%). Participants also emphasised addressing upstream drivers of MASLD/MASH through food environment reform, lifestyle education, and community-based models of prevention, testing, and care.

Why this matters now

The study highlights the rapid rise in metabolic conditions such as obesity and T2D, which drive the growing global burden of liver disease. Many of the recommended interventions overlap with existing prevention strategies for cardiovascular disease, diabetes, and other NCDs. This alignment offers an efficient opportunity for health systems: integrating liver health is feasible, evidence-based, cost-effective, and can strengthen broader NCD responses.

“The current absence of MASLD/MASH from WHO’s formal NCD priorities limits policy traction, resource allocation, and the development of coordinated national strategies,” states Jeffrey Lazarus, head of the Public Health Liver Group at ISGlobal and Professor at the CUNY Graduate School of Public Health and Health Policy in NYC. “By identifying interventions that meet established WHO criteria, the study provides governments and international organisations with actionable guidance that can be implemented immediately.”

Key message for policy-makers

The authors note that the study “shows a strong global consensus among experts that a range of interventions for MASLD/MASH meet the criteria for inclusion as WHO best buys.” By providing a clear and evidence-based prioritisation of interventions, the study aims to accelerate progress against a major yet under-recognised public health threat. It offers governments practical tools to reduce the burden of liver disease while reinforcing long-term NCD prevention and control.

This message carries particular relevance for low- and middle-income countries, where the prevalence of metabolic conditions is increasing quickly yet resources for liver health remain constrained. Interventions such as integrating screening into primary care and automated reflex testing in labs, adopting fiscal policies that promote healthier food environments, and expanding community-based programmes can be implemented at scale with existing infrastructure.

Reference

Lazarus, J V., Agirre-Garrido, L., White, T M., et al. Best buys for metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis: a global Delphi study. Lancet Gastroenterol Hepatol. Dec 12, 2025. https://doi.org/10.1016/S2468-1253(25)00300-0