Authorship:
Jeffrey V Lazarus, Jörn M. Schattenberg, Naim Alkhouri, as Director and Co-directors of the Global Think-tank on Steatotic Liver disease
We believe that steatotic liver disease (SLD) has quietly become one of the defining challenges of the metabolic health era we are now experiencing. The 2025 flagship Global Think-tank on Steatotic Liver Disease event, which we led, convened 125 leaders and practitioners across medicine, policy, public health, civil society and industry.
What emerged from those discussions was not a lack of knowledge, but a clear signal: the field is ready to move from understanding to implementation. This Nature Health Comment reflected that shift and set out what needed to happen next.
Why is steatotic liver disease still a blind spot in the metabolic health crisis?
SLD, particularly metabolic dysfunction-associated steatotic liver disease (MASLD), sits at the centre of the metabolic health crisis, closely linked to indicator conditions like obesity and type 2 diabetes.
Yet it is rarely addressed as part of that continuum. Instead, it remains under-recognised and often diagnosed late, when complications such as fibrosis, cirrhosis, liver cancer or cardiovascular disease have already developed. This gap between prevalence and visibility has allowed SLD to expand alongside other non-communicable diseases (NCDs) without receiving comparable attention or investment.
If we understand the disease, what is holding progress back?
The barrier is no longer scientific. There is a strong evidence base for prevention, early detection and management, but this has not translated into consistent policy or practice. SLD remains largely absent from national strategies, underrepresented in global health frameworks and fragmented across clinical pathways.
The result is a system in which diagnosis comes too late, care is poorly coordinated and opportunities for prevention are missed. The gap is not in what we know, but in how health systems are organised to act on it.
What is the Global Think-tank on Steatotic Liver Disease trying to change?
The Global Think-tank on Steatotic Liver Disease was established to address this disconnect.
It connects science, policy, care—and people—in advancing global recognition of SLD, especially MASLD/MASH, as a key component of the metabolic health crisis.
At the Think-tank, we foster inclusive dialogue across disciplines and lived experiences, expand a diverse community of practice, and accelerate the integration of liver health into national and global NCD agendas.
The 2025 global event marked a pivot from discussion to direction, aligning stakeholders around a focused set of priorities for change.
What are the most critical priorities for action right now?
In Nature Health, together with Think-tank colleagues, we focused on catalysing change through four practical areas:
- Recognition: Embedding SLD within global and national noncommunicable disease strategies, especially as it relates to the voting of the World Health Assembly resolution on Steatotic Liver Disease in May 2026
- Detection: Expanding early diagnosis through non-invasive testing, particularly in primary care
- Integration: Aligning care across specialties and linking liver health with broader metabolic pathways
- Implementation: Scaling models and innovations already shown to work in real-world settings
These priorities build on existing systems and demonstrate that progress is achievable without waiting for new breakthroughs
Why do the next few years matter?
The period leading to 2027 offers a critical window to reposition SLD within global health agendas.
Upcoming milestones, particularly those linked to universal health coverage and broader NCD strategies, provide opportunities to embed SLD into policy frameworks where it has historically been absent. Aligning efforts around this timeline creates both focus and accountability.
Without this change taking place, the current trajectory—rising prevalence, late diagnosis and increasing pressure on health systems—is likely to continue.
What is the key takeaway?
SLD is no longer an emerging issue. It is an established component of the global metabolic public health threat. The question is not whether solutions exist, but whether they will be implemented at scale.
Our Comment reflects a need to focus beyond building knowledge to delivering real-world impact. The opportunity is clear. The next step is now more coordinated action at scale and without delay.