Liver Diseases: Impact, Prevention, and Early Diagnosis

Liver diseases represent a significant burden on global health, with about two million deaths annually worldwide, equivalent to 4% of all deaths, predominantly due to cirrhosis and hepatocellular carcinoma [1]. 

The World Health Organization (WHO) estimates that viral hepatitis causes 1.3 million deaths per year, with 3,500 daily deaths, making it the second leading infectious cause of mortality [2]. Other diseases, such as metabolic dysfunction-associated steatotic liver disease (MASLD), are also highly relevant, affecting up to 38% of the global adult population [1]. 

In Brazil, data from the Ministry of Health confirm more than 826,000 cases of viral hepatitis from 2000 to 2024, with 41.5% being hepatitis C and 36.6% hepatitis B [3]. Given this scenario, the need for effective strategies for prevention and early diagnosis of liver diseases is reinforced. This topic will be further explored below, with information that contributes to timely identification, clinical management, and reduction of the impact of these conditions on public health. Enjoy your reading!

Liver: An Essential Organ for Human Life

The liver is a vital organ responsible for multiple essential functions in maintaining human homeostasis. Its functions include [4]: 

• Metabolism of carbohydrates, lipids, and proteins;
• Glycogen storage;
• Synthesis of plasma proteins (such as albumin and coagulation factors);
• Production and secretion of bile;
• Detoxification of xenobiotics and metabolites;
• Regulation of blood volume;
• Modulation of the immune system through hepatokine secretion and interaction with immune cells.

The liver also plays a role in endocrine regulation and energy metabolism, being fundamental for maintaining blood glucose and fatty acid metabolism [4]. 

Liver Dysfunction: What Can Happen

When the liver is unable to perform its metabolic, synthetic, regulatory, and immunological functions, liver dysfunction occurs. 

Clinical consequences vary depending on severity and etiology, and may include jaundice, coagulopathy (due to decreased synthesis of coagulation factors), hepatic encephalopathy (due to accumulation of ammonia and other toxins), hypoglycemia (due to impaired gluconeogenesis), ascites and edema (due to hypoalbuminemia), as well as predisposition to infections and associated renal failure (hepatorenal syndrome) [4,5]. 

Dysfunction may be acute, such as in acute liver failure (e.g., acetaminophen intoxication, viral hepatitis, drugs), or chronic, such as cirrhosis, often associated with alcohol consumption or viral hepatitis. In acute cases, rapid deterioration with risk of death may occur, while in chronic cases there is slow progression, with manifestations such as portal hypertension, esophageal varices, and risk of hepatocellular carcinoma [4,5]. 

Pathophysiological mechanisms include hepatocellular necrosis, oxidative stress, mitochondrial dysfunction, inflammation, and progressive fibrosis. Endocrine factors, such as insulin resistance and hormonal changes, also contribute to worsening the condition. 

Laboratory and imaging evaluation is essential for diagnosis and monitoring, but conventional tests have limitations in early detection [4,5]. 

How to Improve Liver Health in Daily Life

Maintaining liver health depends on everyday lifestyle choices, which directly impact liver function and the risk of disease progression. Below are practical guidelines based on scientific evidence. 

Alcohol in Moderation

Alcohol can damage liver cells and lead to fibrosis (scarring), increasing the risk of cirrhosis and liver cancer. Even small amounts of alcohol can worsen conditions such as fatty liver, especially in people who are overweight or diabetic. 

Moderate consumption (up to 20g/day for women and 30g/day for men) is already associated with a higher risk of disease progression. Ideally, alcohol consumption should be avoided or minimized to protect the liver [6]. 

Weight Control and Physical Activity

Maintaining a healthy weight is fundamental. Losing body weight can help reduce fat accumulation in the liver and improve inflammation, potentially reversing part of the fibrosis. Regular exercise, such as walking, cycling, or swimming, for at least 150 minutes per week, provides benefits even without weight loss, improving both liver and heart health. Diet and physical activity together are more effective than either alone [7]. 

Risks of Self-Medication and Supplement Use

Self-medication or supplement use should not be done without medical or nutritional guidance. Many natural products or supplements can overload the liver and cause damage, even if marketed as “detox” or “natural.” There is no evidence that supplements or “detox” teas cleanse or regenerate the liver [8]. 

Healthy Eating

The most recommended dietary pattern is one rich in vegetables, fruits, whole grains, olive oil, fish, and white meats, with low sugar, saturated fat, and processed meats. Reducing ultra-processed foods, sodas, and sweets is essential. There is no scientifically proven list of “detox foods”; what matters is a balanced and varied dietary pattern, not isolated foods [7]. 

How to Assess Liver Function: Recommended Tests and Indications

Liver function assessment involves laboratory and imaging tests, with indications and frequency guided by the patient’s risk profile. Below are the main related tests. 

Blood Tests

The main blood tests for liver function assessment are ALT/TGP, AST/TGO, GGT, alkaline phosphatase, and bilirubin (total and fractions) [8,9]. Each has specific indications and utilities [8-10]: 

• ALT (alanine aminotransferase/TGP): More specific for hepatocellular injury, as it is mainly present in the liver. ALT elevations suggest liver damage, being useful in screening for viral hepatitis, non-alcoholic fatty liver disease, and drug toxicity;
• AST (aspartate aminotransferase/TGO): Present in the liver but also in other tissues (heart, skeletal muscle). AST elevations may indicate liver injury but can also occur in muscle or heart diseases. An AST>ALT pattern suggests alcoholic etiology or advanced cirrhosis;
• GGT (gamma-glutamyl transferase): Useful to confirm hepatic origin of alkaline phosphatase elevation. GGT alone is not specific for liver disease, as it may be elevated in kidney, lung, and pancreatic diseases. It is indicated when cholestasis or chronic alcohol use is suspected;
• Alkaline phosphatase: Marker of cholestasis and biliary injury. Elevations suggest bile duct obstruction or infiltrative liver diseases. When elevated alone, it should be confirmed with GGT to differentiate hepatic from bone origin;
• Bilirubin (total, direct, and indirect): Evaluates hepatic conjugation and excretion capacity. Elevation of direct (conjugated) bilirubin indicates excretory dysfunction or biliary obstruction; elevation of indirect bilirubin suggests hemolysis or Gilbert’s syndrome. 

Imaging Tests

Abdominal ultrasound is the initial method to assess steatosis, focal lesions, and signs of cirrhosis. Elastography (via US or MRI) is indicated for quantification of liver fibrosis, especially in patients with increased risk or persistent laboratory abnormalities. Computed tomography is reserved for investigating masses, complications, or when US is inconclusive [11]. 

Suggested Periodicity by Profile

For low-risk patients, annual evaluation is sufficient. In individuals with increased risk (obesity, type 2 diabetes, alcohol consumption, chronic use of medications), more frequent monitoring is recommended, according to clinical evolution and laboratory findings. 

The approach should always consider the clinical context, history of exposure to risk factors, and integration of laboratory and imaging findings to guide investigation and management [6]. 

Liver Detoxification: What Is Myth and What Actually Helps

There are popular myths about “liver detoxification,” involving claims that diets, supplements, or procedures can “cleanse” the liver in a few days or quickly eliminate toxins. However, there is no scientific basis for these claims [12]. 

The liver already performs physiological detoxification continuously through enzymatic pathways (phases I and II), efficiently metabolizing xenobiotics and endogenous waste in healthy individuals. Systematic reviews and analyses of popular supplements show that there is no robust evidence that products marketed as “liver cleanse” or “detox” provide measurable benefits to liver function or accelerate toxin elimination [12]. 

Evidence-based practices to support liver health focus on lifestyle factors. Recommended interventions include a balanced diet (with restriction of ultra-processed foods and sugars), body weight control, regular physical activity, and moderation or abstinence from alcohol, especially in patients with metabolic risk factors [12]. 

Good-quality sleep and reduction of sedentary behavior are also associated with lower risk of non-alcoholic fatty liver disease and improved metabolic profile. These measures can improve laboratory markers and reduce disease progression, but they do not guarantee “detoxification” or rapid reversal of damage [12]. 

Do Genetic Tests Play a Role in Liver Health?

Genetic tests play an important role in identifying rare monogenic liver diseases, such as hereditary hemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency, genetic cholestasis, and other conditions that may present with nonspecific liver abnormalities or a suggestive family history [13,14]. 

When Can They Be Indicated?

Indication occurs mainly in patients with atypical clinical presentation, early onset, positive family history, or when conventional tests do not clarify the etiology. Genetic testing is also useful for family screening and genetic counseling, allowing early diagnosis and personalized management [13,14]. 

In common liver diseases, genetic variants (such as in the PNPLA3 and TM6SF2 genes) may influence risk and severity, but the clinical use of genetic testing for population risk stratification is not yet routinely recommended. Genetic testing may be considered in specific situations of high family risk or when there is suspicion of a monogenic disease [13,14]. 

It is important to clarify that genetic testing does not replace liver function tests. Laboratory tests (ALT, AST, bilirubin, ALP, GGT, albumin, prothrombin time) directly assess the functional state and degree of liver injury at the time of testing, while genetic testing identifies predisposition or etiological cause, without providing information on activity, severity, or disease progression. 

Clinical management requires integration of genetic findings with biochemical data, imaging, and clinical history for a complete evaluation [13,14]. 

What Warning Signs Can I Identify in the Patient?

As mentioned, early diagnosis of liver diseases is essential to prevent severe clinical outcomes. Below is a quick visual checklist of warning signs for liver disease that can be easily identified [9]: 

• Jaundice: Yellowish discoloration of the skin and/or sclera (eyes), often associated with bilirubin accumulation. It is a classic sign of liver dysfunction and may indicate cholestasis, acute hepatitis, or advanced liver disease;
• Dark urine: Presence of urine with a color similar to “black tea” or “cola,” suggesting bilirubinuria, common in cholestasis or hepatitis;
• Pain or swelling in the right upper quadrant: Discomfort, pain, or sensation of mass/swelling in the right subcostal region may indicate hepatomegaly, liver capsule distension, cholecystitis, or complications such as ascites;
• Persistent nausea: Gastrointestinal symptoms such as nausea, vomiting, and anorexia are common in acute hepatitis and may accompany other systemic manifestations;
• Fadiga intensa: cansaço desproporcional, astenia ou mal-estar generalizado são sintomas frequentes em doenças hepáticas, especialmente nas formas crônicas ou agudas graves. 

FibroMax: New SYNLAB Technology for Fibrosis and Liver Health Assessment

FibroMax is a non-invasive laboratory test indicated for integrated assessment of liver injury, helping identify the risk of fibrosis, cirrhosis, and hepatocellular carcinoma associated with different clinical conditions, especially metabolic and lifestyle-related. 

It represents an important alternative to liver biopsy in selected contexts, contributing to patient follow-up and risk stratification. 

FibroMax analysis is based on the combination of five validated tests, which assess different aspects of liver disease. These tests include estimation of fibrosis degree (FibroTest), hepatic steatosis (SteatoTest), necroinflammatory activity of viral origin (ActiTest), inflammation associated with metabolic steatosis, such as non-alcoholic steatohepatitis – NASH (NASHTest), and inflammation related to alcohol consumption (ASHTest). 

The test is particularly indicated for patients with hepatic steatosis without apparent fibrosis, as well as for those with more advanced lesions, such as significant fibrosis or NASH, in whom there is a higher risk of progression to cirrhosis and liver cancer. Thus, FibroMax provides relevant support for clinical decision-making and disease monitoring. 

Together, FibroMax consolidates itself as a comprehensive diagnostic tool for liver health assessment, integrating multiple markers into a single analysis and expanding the possibilities for early detection and monitoring of liver diseases. 

Get to Know SYNLAB Group, a Reference in Medical Diagnostic Services!

Performing precise and updated tests is essential for more accurate diagnoses and better treatment guidance. SYNLAB is here to help you. 

We provide diagnostic solutions with strict quality control to the companies, patients, and physicians we serve. We have been in Brazil for over 10 years, operate in 36 countries across three continents, and are leaders in service provision in Europe. 

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Frequently Asked Questions (FAQ)

Why are liver diseases a public health problem?

Because they cause millions of deaths annually worldwide, mainly due to cirrhosis and hepatocellular carcinoma. 

What are the main causes of liver diseases?

Viral hepatitis, alcohol consumption, metabolic diseases such as MASLD, obesity, and diabetes are among the main causes. 

What happens when the liver goes into dysfunction?

Jaundice, ascites, hepatic encephalopathy, coagulation abnormalities, and increased risk of infections may occur. 

Is moderate alcohol consumption safe for the liver?

Even amounts considered moderate can worsen liver diseases, especially in people with risk factors. 

Does physical activity really help liver health?

Yes. Regular exercise reduces liver fat and inflammation, even without significant weight loss. 

Do “detox” products really cleanse the liver?

No. There is no scientific evidence that supplements or “detox” teas improve or regenerate liver function. 

Which tests help in early evaluation of liver diseases?

Blood tests, imaging, and non-invasive tests such as FibroMax assist in early detection and monitoring. 

Does FibroMax replace liver biopsy?

In many cases, yes, as a non-invasive tool for risk stratification. 

Who can benefit from FibroMax?

Patients with steatosis, metabolic risk, alcohol consumption, or suspected fibrosis. 

Is the FibroMax Test Invasive?

No. It is performed using a blood sample. 

References: 

[1] Devarbhavi H, Asrani SK, Arab JP, Nartey YA, Pose E, Kamath PS. Global burden of liver disease: 2023 update. J Hepatol. 2023 Aug;79(2):516-537. doi: 10.1016/j.jhep.2023.03.017

[2] WHO. Hepatitis. Disponível em: https://www.who.int/health-topics/hepatitis#tab=tab_1 Acesso em: 16/12/2025

[3] Associação Paulista de Medicina. Ministério da Saúde apresenta dados referentes às Hepatites Virais. Disponível em: https://www.apm.org.br/ministerio-da-saude-apresenta-dados-referentes-as-hepatites-virais/ Acesso em: 16/12/2025

[4] Trefts E, Gannon M, Wasserman DH. The liver. Curr Biol. 2017 Nov 6;27(21):R1147-R1151. doi: 10.1016/j.cub.2017.09.019

[5] Perez Ruiz de Garibay A, Kortgen A, Leonhardt J, Zipprich A, Bauer M. Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients. Crit Care. 2022 Sep 26;26(1):289. doi: 10.1186/s13054-022-04163-1

[6] Kanwal F, Shubrook JH, Adams LA, Pfotenhauer K, Wai-Sun Wong V, Wright E, Abdelmalek MF, Harrison SA, Loomba R, Mantzoros CS, Bugianesi E, Eckel RH, Kaplan LM, El-Serag HB, Cusi K. Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2021 Nov;161(5):1657-1669. doi: 10.1053/j.gastro.2021.07.049

[7] Sheikh MY, Younus MF, Shergill A, Hasan MN. Diet and Lifestyle Interventions in Metabolic Dysfunction-Associated Fatty Liver Disease: A Comprehensive Review. Int J Mol Sci. 2025 Oct 2;26(19):9625. doi: 10.3390/ijms26199625

[8] Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, Abdelmalek MF, Caldwell S, Barb D, Kleiner DE, Loomba R. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023 May 1;77(5):1797-1835. doi: 10.1097/HEP.0000000000000323

[9] Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017 Jan;112(1):18-35. doi: 10.1038/ajg.2016.517

[10] Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med. 2000 Apr 27;342(17):1266-71. doi: 10.1056/NEJM200004273421707

[11] Benson, A. B., D’Angelica, M. I., Abbott, D. E., Anaya, D. A., Anders, R., Are, C., Bachini, M., Borad, M., Brown, D., Burgoyne, A., Chahal, P., Chang, D. T., Cloyd, J., Covey, A. M., Glazer, E. S., Goyal, L., Hawkins, W. G., Iyer, R., Jacob, R., Kelley, R. K., Kim, R., Levine, M., Palta, M., Park, J. O., Raman, S., Reddy, S., Sahai, V., Schefter, T., Singh, G., Stein, S., Vauthey, J., Venook, A. P., Yopp, A., McMillian, N. R., Hochstetler, C., & Darlow, S. D. (2021). Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, 19(5), 541-565. Retrieved Dec 17, 2025, from https://doi.org/10.6004/jnccn.2021.0022

[12] Gardezi SA, Jawad MA, Albahrani MY. Breaking the silence on liver myths: a call for evidence-based practice. Clin Med (Lond). 2025 Oct 28;25(6):100525. doi: 10.1016/j.clinme.2025.100525

[13] Allouni S, Ala A. Rare but relevant: Genetic liver disease in the general medical setting. Clin Med (Lond). 2025 Nov 19;25(6):100535. doi: 10.1016/j.clinme.2025.100535. Epub ahead of print. PMID: 41270864.

[14] Schonfeld EA, Brown RS Jr. Genetic Testing in Liver Disease: What to Order, in Whom, and When. Clin Liver Dis. 2017 Nov;21(4):673-686. doi: 10.1016/j.cld.2017.06.001. Epub 2017 Jul 29. PMID: 28987255.