From Clinic to Community: A Public Health Framework for Metabolic Dysfunction-associated Steatotic Liver Disease...

India is witnessing a rapid rise in metabolic dysfunction-associated steatotic liver disease (MASLD), driven by the country's expanding population with obesity, type 2 diabetes (T2D), and other metabolic comorbidities. Despite this growing burden, structured liver disease screening is absent from routine noncommunicable disease (NCD) services at the primary care level.

A majority of MASLD diagnoses in India occur only after progression to advanced fibrosis or cirrhosis, even among individuals regularly engaged with healthcare systems for diabetes or hypertension. Primary health centers (PHCs) and community health centers (CHCs) currently lack standardized protocols for liver risk stratification, leading to critical missed opportunities for early intervention.

This article outlines a scalable, systems-integrated model for community-based liver care, piloted at the All India Institute of Medical Sciences (AIIMS), Rishikesh. The model incorporates noninvasive fibrosis scoring tools (FIB-4, APRI), selective deployment of nurse-led FibroScan services, maternal hepatitis B virus screening, lifestyle modification strategies, and digital follow-up systems-seamlessly embedded within existing maternal health and NCD platforms. Insights: A real-world vignette from an urban diabetes outreach program in Kolkata illustrates the diagnostic gap: a high-risk patient remained undiagnosed for MASLD despite multiple healthcare encounters. International experiences, such as the Gwent model in Wales, further reinforce the feasibility of decentralized hepatology through community triage, nurse-led services, and simplified biochemical tools.

India stands at a pivotal moment in redefining hepatology as a preventive, public health-oriented discipline. By embedding liver screening within existing NCD frameworks, leveraging task-sharing, and mobilizing digital infrastructure and public-private partnerships, India can develop a replicable model for early MASLD detection and intervention. This community hepatology framework-if scaled nationally-has the potential to position India as a global leader in MASLD prevention for low- and middle-income countries.