Liver Health Starts Before the Clinic: Rethinking Where Liver Disease Prevention Begins

Before the test, before the diagnosis—liver disease prevention starts with us, and where we live, work, and eat.

[This post has been co-written by Dana Ivancovsky-Wajcman, postdoctoral researcher at ISGlobal, and Jeffrey V. Lazarus, head of the Public Health Liver Group at ISGlobal.]

Liver health doesn’t suddenly fall apart overnight. It’s shaped over years—by what we eat, how we move, the stress we carry, and the systems we live in. And yet, most strategies to prevent liver disease still focus on what happens inside a doctor’s office.

But what if we’ve been looking in the wrong places?

What if the key to stopping liver disease lies in classrooms, kitchens, and community spaces—not just health centres?

The truth is, conditions like metabolic dysfunction-associated steatotic liver disease (MASLD) often develop silently for many years before symptoms show up. That’s why prevention has to start early—and involve more than just the healthcare system.

The Invisible Beginnings of Liver Disease

Beyond genetic components, lifestyle factors play a crucial role in why some people develop MASLD. The Western lifestyle — marked by high consumption of processed meats, refined grains, sweets, and alcohol, along with a low intake of vegetables, fruits, nuts, legumes, and whole grains as well as physical inactivity, smoking and excessive alcohol consumption — plays a major role in the development of MASLD. Lifestyle habits are shaped early in life and influence health in adulthood. For example, studies have found that when mothers’ diets are unhealthy during pregnancy, their children may be more likely to develop liver problems like MASLD later in life. Breastfeeding might help protect against liver problems like MASLD later in life, while eating a lot of sugar and fat can increase the chances of developing it. Similarly, physical inactivity and increased screen time in childhood heighten the risk of severe MASLD in adulthood. 

While behavioural lifestyle changes and weight loss are the main therapies for MASLD, they are challenging to achieve and maintain, especially for vulnerable populations. That’s why establishing healthy lifestyle habits from an early stage is the most effective way in preventing MASLD and supporting overall metabolic health.

Metabolic health is the body's ability to maintain balanced levels of blood sugar, cholesterol, blood pressure, and other key factors. When this process functions well, it helps prevent non-communicable diseases (NCDs) like diabetes, cardiovascular disease, and MASLD

The Role of Educators and Early Childhood Environments

Prevention should start early — but how early? Ideally, during pregnancy or even before. It’s important for expectant mothers to be mindful of their diet, and just as important for their environment to support healthy choices. This can be achieved through nutritional education in antenatal classes and by offering dedicated, subsidised physical activity programmes tailored specifically for pregnant women.

These efforts should also continue into the first 1,000 days. This means support for breastfeeding, such as free breastfeeding consultations in hospitals and primary care, and education courses for parents that cover a healthy diet and feeding relationships.

During early childhood, parents or legal guardians are children’s most important role models, including in establishing eating habits. Therefore, family meals should be strongly encouraged, as they’re linked to healthier eating habits and improved mental wellbeing in children and adolescents.

In addition, schools and parents must work hand in hand to promote healthy behaviour/choices. This includes avoiding sugar-laden meals, banning sugary drinks, and limiting sweets at birthday celebrations. Instead, they should ensure access to nutritious, balanced food, such as through healthy school catering or school-community gardens. Creating a healthy food environment in schools is especially important for vulnerable children, such as those facing food insecurity and lacking parental support, as food insecurity is also linked to MASLD. Children should also be motivated to move regularly during and after school.

Why Medical Education Still Falls Short

Imagine starting a job at a bakery—the smell of warm pastries filling the air, and how easy it is to grab one fresh out of the oven. Without even realising it, your carb intake goes up.

That’s the thing about health decisions: they’re rarely just a matter of personal choice. Our environment, education, workplace, and upbringing all shape our habits. But even when people want to make healthier choices, the healthcare system doesn’t always provide the support they need.

Many healthcare providers would like to help people improve their diet or activity levels—but the system makes it difficult. Most medical schools still don’t adequately teach nutrition or lifestyle interventions, leaving many physicians without the tools or confidence to offer meaningful, personalised advice. On top of that, time is limited during appointments, and there’s often a perception that lifestyle change isn’t really the doctor’s responsibility.

This combination of barriers results in missed opportunities.

A Call for Cross-Sector Prevention

In addition to education and awareness, making healthy choices should feel like the easiest option. Preventing liver disease—and promoting health more broadly—requires collaboration across sectors. Educators, healthcare professionals, community leaders, and policymakers all have a part to play, including in the international arena.

We also need to expand our idea of who educates about health. Teachers, sports coaches, youth workers, parents, and even local shopkeepers can all be “health educators beyond healthcare.” These everyday influencers help shape habits and attitudes, often more directly than clinical settings ever could.

That’s why liver health, along with other metabolic conditions, should be woven into school curricula, community programmes, and family education—not as an add-on, but as a foundation for lifelong wellbeing.

Conclusion

Liver disease prevention starts with us—making healthy choices in our daily lives. From the food we eat to staying active and avoiding harmful habits, our decisions shape our long-term health. But we are not alone in this journey—our environment and community play a crucial role too.

For example, eating more fruits and vegetables becomes second nature when they’re affordable and easy to find. Avoiding sugary drinks is simpler when advertising is restricted, taxes are applied, and public water fountains are readily available. The same goes for physical activity: someone might be motivated to walk to work—but if the route isn’t safe or easily walkable, they’ll likely end up on public or private transportation. Our surroundings shape our habits.

That’s why–when we take a step back–we realise that everyone has a part to play—parents guide us toward healthy habits, teachers educate us on nutrition, friends encourage active lifestyles, urban planners design walkable spaces, industries offer nutritious food options, and policymakers set public health priorities and oversee the implementation of needed changes.

By taking individual and societal responsibility for our health and supporting one another, we can create a healthier future for all.