Why Steatotic Liver Disease Deserves a Central Role in NCD Policy, with Arun Sanyal, MD

Steatotic liver disease (SLD), encompassing both alcohol-related and metabolic dysfunction-associated forms, now affects up to 30–40% of adults and 10% of children. With rising incidence and prevalence, global projections estimate the number of people living with SLD may double by 2030 compared to 2015—an alarming trend with far-reaching public health implications.

With more patients progressing to advanced forms like steatohepatitis due to aging, prolonged exposure, and increasing rates of diabetes, SLD is not just highly prevalent but also poses an existential health challenge, particularly given its interconnectivity with other major chronic diseases, as highlighted at a side event at the 78th World Health Assembly (WHA78) in Geneva, Switzerland, titled “Together for Better Liver Health – Strengthening Public Health Responses to Metabolic Disease.”

In an interview with HCPLive, Arun Sanyal, MD, director of the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health at Virginia Commonwealth University, emphasizes SLD’s role as a noncommunicable disease (NCD) closely intertwined with insulin resistance, type 2 diabetes, cardiovascular disease, and metabolic syndrome.

“[SLD] is not only a very important NCD in its own right, but it plays a critical role in the development of what was conventionally considered the big 3: cardiovascular disease, type 2 diabetes, and cancer,” Sanyal explained.

Importantly, he says the liver may not merely be a passive marker of disease but a causal organ in the development of these conditions, noting its central role in cholesterol production, systemic inflammation, and metabolic dysregulation. Consequently, SLD increases mortality from cardiovascular disease and cancer beyond what is explained by obesity alone.

Sanyal describes his optimism regarding the growing recognition from other specialties regarding the liver’s role in metabolic disease. Specifically, he highlights new ADA guidelines and dedicated sessions on SLD at the ADA Scientific Sessions, as well as early signals of attention at the World Health Assembly.

However, he notes meaningful progress requires formal policy integration: MASLD must be recognized as a core NCD alongside diabetes, heart disease, and cancer.

“Eventually, this needs to translate into a more formal recognition of MASLD as a critical part of the NCD spectrum that is linked to cardiovascular disease, diabetes, cancer, and the other NCDs,” Sanyal said. “Policies that are developed around NCDs must integrate liver disease as part of that in order to develop care paradigms. If you leave major parts of the syndrome out of the policy, if you don't take into account their causal role in development of disease, then your entire approach is going to be based on putting band aids on established disease.”

Accordingly, Sanyal advocates for a paradigm shift toward prevention. Rather than reactively treating end-organ damage, he says public health strategies should identify individuals at metabolic risk early and intervene to preserve liver, heart, and kidney function—supporting not only longer lives but better quality of life and productivity.

Editors’ note: Sanyal reports relevant disclosures with Akero, Amgen, AstraZeneca, Boehringer Ingelheim, Genentech, Gilead Sciences, GlaxoSmithKline, Intercept Pharmaceuticals, Inventiva, Merck, Novartis Pharma, Novo Nordisk, Regeneron Pharmaceuticals, Salix Pharmaceuticals, Boston Pharma, Takeda Pharmaceuticals, 89 Bio, and others.

Reference

Global Liver Institute. Global Health Leaders Convene at WHA78 Side Event to Advocate for Steatotic Liver Disease as a Core Non-Communicable Disease. May 22, 2025. Accessed July 23, 2025. https://globalliver.org/global-health-leaders-convene-at-wha78-side-event-to-advocate-for-steatotic-liver-disease-as-a-core-non-communicable-disease/