Global Liver Institute releases the 4th edition of the Global State of Liver Health Report

The 2025 Global State of Liver Health Report — from the Global Liver Institute — provides the most comprehensive global analysis to date of liver disease burden, drivers, and disparities, incorporating data and perspectives from countries representing over half the world’s population. This year’s update highlights emerging trends in metabolic liver disease, ongoing challenges in prevention and care, and urgent priorities for clinicians, health systems, and policymakers to improve liver health outcomes worldwide.

In this insightful interview, Larry R. Holden (President and Chief Executive Officer, Global Liver Institute) outlines how the 4th edition of the Global State of Liver Health Report advances GLI’s mission to elevate liver disease as a global public health priority. He highlights major shifts in the global burden of liver disease, including the rapid rise of metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH), alongside increasing rates of alcohol-associated liver disease. Finally, we discuss the urgent calls to action for policymakers, clinicians, and health systems to improve prevention, diagnosis, and equitable access to care worldwide.

The Global State of Liver Health Report is Global Liver Institute’s flagship resource for mapping liver health worldwide. This 4th edition analyzes data and policies across 40 countries, representing more than half the world’s population, and incorporates perspectives from clinicians, researchers, public-health officials, and patients. It is created to address the persistent lack of global awareness and prioritization of liver disease despite its rapidly escalating burden.

This report continues to advance GLI’s mission:

• Making the true scope of liver disease visible through evidence on prevalence and burden, risk factors, and inequities in access to care—strengthening advocacy efforts.
• Equipping national and regional partners with localized data and case studies that can be used directly in policymaker engagement.
• Elevating patient and civil society voices and reinforcing GLI’s role as a global convener, driving a unified conversation on liver health.
• Underscoring GLI’s core message that “Liver Health Is Public Health” by positioning liver disease within the broader agendas of noncommunicable diseases, cancer prevention, and infectious disease control.

The report underscores an immense and growing global public health concern. Approximately 844 million people are living with chronic liver disease, and 2 million deaths occur each year, nearly half from viral hepatitis and the remainder from cirrhosis or liver cancer. The rapid rise of MASLD/MASH is highlighted as one of the largest emerging drivers: about one in four people globally are affected, with significant progression toward advanced disease.

The most urgent unmet needs globally fall into three areas:

1. Prevention: Many countries often lack strong policies with regard to alcohol, obesity and nutrition strategies, and comprehensive viral hepatitis prevention programs.
2. Diagnosis: Under-screening, under-diagnosis, and misdiagnosis of MASLD, MASH, and alcohol-related liver disease are widespread, leading to late-stage and liver cancer presentations and missed opportunities for intervention.
3. Care: Access to care, such as antiviral therapy, non-invasive fibrosis assessment, imaging, surveillance for liver cancer, and transplantation, remains vastly unequal, especially across low- and middle-income countries. Fragmented care pathways and limited workforce capacity compound these challenges.

The report identifies several global trends shaping the future of liver health. The first is the rapid spread of obesity, diabetes, and metabolic diseases into regions previously considered low-risk, including Southeast Asia, parts of Africa, and Latin America. These trends sharply accelerate the prevalence of MASLD and MASH. A second trend is the normalization of high-risk alcohol use, especially among younger populations, contributing to rising rates of alcohol-associated liver disease and cirrhosis. Third, viral hepatitis remains a leading and preventable cause of liver cancer and liver-related mortality; despite the availability of vaccines and curative therapies, many countries have not fully implemented elimination strategies.

Across all regions, the report finds that liver disease disproportionately affects working-age adults, with profound economic consequences. At the same time, the report highlights major success stories – such as Egypt’s large-scale hepatitis C elimination effort – that demonstrate the impact of political will, financing, and system-level coordination.

GLI calls on policymakers to elevate liver health within national NCD strategies, cancer-control plans, and infectious-disease agendas, ensuring that liver disease receives attention commensurate with its scale. Governments are encouraged to strengthen prevention policies, including alcohol taxation and marketing restrictions, nutrition and obesity interventions, expanded hepatitis B vaccination, and robust harm-reduction programs. Health systems are called upon to expand equitable access to screening, diagnosis, and treatment by integrating liver-health services into primary care, deploying non-invasive testing, ensuring coverage of antiviral therapies, and establishing clear referral pathways. Clinicians and professional societies are encouraged to implement risk-based screening, update clinical guidelines, adopt non-invasive fibrosis assessments, and collaborate across specialties. Finally, GLI urges countries to invest in surveillance and national registries, along with public education campaigns to raise awareness of liver-disease risks and symptoms.

If implemented, the recommendations in this report could meaningfully shift liver-disease outcomes worldwide. By promoting early detection, particularly among high-risk groups such as people living with diabetes, obesity, or chronic hepatitis, countries can reduce the prevalence of late-stage cirrhosis and liver cancer. Strong data systems and cross-country comparisons can guide policymakers toward the most effective interventions and expose gaps that demand attention. The report’s emphasis on equitable access will help ensure that lifesaving tools – antiviral therapies, fibrosis testing, imaging, and transplantation – are available across socioeconomic and geographic contexts. By integrating liver health into broader public health priorities, countries can create more efficient, patient-centered care pathways that reduce duplication and strengthen long-term disease management. Ultimately, this edition equips governments, health professionals, and advocates with the evidence, strategies, and global momentum needed to reduce preventable deaths and improve the quality of life for millions of people living with liver disease. We invite you to download the report and make use of this resource.