Protect Against Liver Disease This Liver Awareness Month by Learning the Risks, Symptoms

Liver Awareness Month, observed each October, increases public understanding of the causes, symptoms, and outcomes of liver disease and highlights steps that can be taken at both the individual and federal levels to help curb its rise.

Understanding the Causes and Risk Factors of Liver Disease

Liver disease affects approximately 1.8%, or 4.5 million, of US adults, with men affected twice as often as women.¹ It is the cause of roughly 57,000 deaths per year in the US and about 2 million, or 4%, of deaths globally, primarily due to complications of cirrhosis.

Liver disease can arise from parasites and viruses infecting the liver, causing inflammation that impairs its function.² The most common types of liver infection are hepatitis viruses, specifically hepatitis A, B, or C. These viruses can be transmitted through blood or semen, contaminated food or water, or close contact with an infected person.

Autoimmune liver diseases, including autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis, occur when the immune system mistakenly attacks parts of the body. Liver disease can also be genetic, caused by inherited mutations that lead to the buildup of substances in the liver. Genetic liver diseases include hemochromatosis, Wilson disease, and α-1 antitrypsin deficiency.

Additional common causes of liver disease include long-term alcohol use, fat accumulation in the liver, certain medications and herbal mixes, or repeated exposure to toxic chemicals. Therefore, risk factors for liver disease include ongoing moderate to heavy alcohol use, obesity, type 2 diabetes, tattoos or body piercings, and shared needles used for drug injection. Other risks are exposure to other people’s blood or body fluids, unprotected sex, contact with chemicals or toxins, and a family history of liver disease.

Progression, Symptoms, and Complications of Liver Disease

Liver disease progresses through 4 stages.¹ Stage 1, hepatitis, involves inflammation of the liver tissues. Stage 2, fibrosis, is characterized by gradual stiffening of the liver as thin bands of scar tissue accumulate. Stage 3, cirrhosis, involves severe, permanent scarring, and stage 4, liver failure, or decompensated cirrhosis, occurs when the liver can no longer meet the body’s functional needs. Without a liver transplant, chronic liver failure is ultimately fatal.

Chronic liver disease often has no symptoms in its early stages, though it may sometimes begin with an episode of acute hepatitis. Early signs can also include upper abdominal pain, nausea or loss of appetite, and fatigue or malaise. As liver function declines, additional symptoms may develop, such as jaundice, dark-colored urine, light-colored stool, digestive difficulties, and weight and muscle loss. Individuals may also experience bad breath, mild cognitive impairment, and pruritus.

Advanced liver disease can affect blood flow, hormones, and nutritional status, leading to visible changes in the skin and nails. Additionally, fluid accumulation may result in swelling of the abdomen, ankles, feet, hands, and face. Gender-specific symptoms can also occur; women may experience irregular menstruation and infertility, while men may experience shrunken testicles and enlarged male breast tissue.

The most serious complications of end-stage liver disease are portal hypertension and primary liver cancer, both of which are leading causes of hospitalization and death among this population. Portal hypertension occurs when scarring compresses the portal vein, causing blood to divert through smaller veins that become enlarged, thin, and prone to rupture, resulting in potentially life-threatening internal bleeding.

Although not all individuals with chronic liver disease develop primary liver cancer, most people who do have the underlying liver condition, as chronic cycles of inflammation, repair, and scarring increase the risk of liver cells transforming into cancer.

Individual Action and Policy Initiatives to Combat Liver Disease

To help prevent liver disease at the individual level, Mayo Clinic recommends drinking alcohol in moderation, getting vaccinated against hepatitis, avoiding contact with others’ blood and body fluids, and maintaining a healthy weight.² Looking more broadly, the American Liver Foundation (ALF) continues to advocate for legislation and research funding during Liver Awareness Month and beyond to reduce the number of individuals affected by liver disease nationwide.³

Specifically, the organization is urging Congress to sustain and expand funding for liver disease research, prevention, and treatment to address this growing public health threat and improve outcomes for millions of Americans. ALF is also advocating for CMS to finalize its proposed rule expanding Medicare Part D coverage for anti-obesity medications, a key step in addressing a major risk factor for liver disease and reducing long-term health care costs.

Additionally, the organization supports several legislative efforts related to both transplant and treatment access. These include the Living Donor Protection Act, which prohibits insurance discrimination against living organ donors and ensures job-protected leave for donation recovery, as well as the Honor Our Living Donors Act, which would expand reimbursement for donor-related expenses, regardless of the recipient’s income.

In terms of treatment access, ALF supports the Safe Step Act, which requires insurers to allow exceptions to step-therapy protocols when clinically appropriate to prevent treatment delays or harm. The organization also backs the HELP Copays Act, which ensures that co-pay assistance and third-party payments count toward patients’ out-of-pocket maximums, improving medication affordability and adherence.

Lastly, it supports the Treat and Reduce Obesity Act, which expands Medicare coverage for intensive behavioral therapy and anti-obesity medications, allowing broader provider participation to help address obesity-related liver disease.

“By expanding access to critical medications that can help address obesity, this effort has the potential to reduce the prevalence of [metabolic dysfunction-associated steatotic liver disease] and the significant health complications associated with it,” Lorraine Stiehl, CEO of the American Liver Foundation, said in a statement.⁴ “For liver patients, this means a chance to prevent the progression of liver disease, improve overall quality of life, and reduce health care burdens caused by untreated obesity and its complications.”

References

1. Liver disease. Cleveland Clinic. Last reviewed October 4, 2023. Accessed October 24, 2025. https://my.clevelandclinic.org/health/diseases/17179-liver-disease
2. Liver disease. Mayo Clinic. August 6, 2025. Accessed October 24, 2025. https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502
3. 2025 legislative priorities. American Liver Foundation. Last reviewed April 28, 2025. Accessed October 24, 2025. https://liverfoundation.org/how-you-can-help/get-involved/advocate/legislative-priorities/
4. American Liver Foundation applauds Biden administration’s proposed rule change on anti-obesity medication coverage under Medicare and Medicaid. News release. American Liver Foundation. November 26, 2024. Accessed October 24, 2025. https://liverfoundation.org/resource-center/blog/american-liver-foundation-applauds-biden-administrations-proposed-rule-change-on-anti-obesity-medication-coverage-under-medicare-and-medicaid/