Treating these diseases separately misses a major opportunity
Nearly half of Mexico's adults carry a liver condition that grows silently in the shadow of diabetes and obesity—diseases the country has long tracked, but whose hepatic companion it has largely ignored. A new paper by researchers at CUNY argues that this blind spot is not a gap in knowledge but a failure of integration: the infrastructure exists, the data exists, and now, for the first time, a treatment exists. What remains is the political and institutional will to see these converging epidemics as a single, coherent crisis.
- Liver disease is killing more than 19,000 Mexicans in a single half-year, yet it remains absent from the national health surveillance systems that track its closest companions—diabetes and obesity.
- Nearly half of Mexican adults meet the criteria for MASLD, and one in five of those cases can escalate into MASH, a severe inflammatory form that opens the door to cirrhosis and liver cancer.
- For years, screening felt futile without a treatment to offer—but the recent approval of the first MASH medication has transformed early detection from a gesture into a genuine clinical intervention.
- Researchers are urging Mexico to add liver blood tests to existing diabetes care programs, expand non-invasive diagnostics through the public system, and fold liver health into the national ENSANUT nutrition survey.
- The path forward is not a new bureaucracy but a reconnection of what already exists—treating the patient as a whole rather than as a series of isolated conditions managed in separate silos.
Mexico is quietly hosting a public health crisis it has yet to fully name. Nearly half of the country's adults carry metabolic dysfunction-associated steatotic liver disease—MASLD—a condition in which fat accumulates in the liver alongside the same cardiometabolic risk factors that define diabetes and obesity. Yet while those two diseases have long occupied Mexico's health surveillance systems, liver disease has remained largely invisible within them.
A new paper by Jeffrey Lazarus of the CUNY Graduate School of Public Health and his colleagues, published in Archives of Medical Research and timed to coincide with the International Congress on Obesity in Mexico City, makes the case plainly: stop treating liver disease as a separate problem and fold it into the chronic care infrastructure already built around diabetes and obesity. A screening study across five Mexican states found 47 percent of participants met MASLD criteria. Liver disease now accounts for nearly 43 percent of cirrhosis cases at Mexican referral centers and ranks as the country's fifth leading cause of death, with over 19,000 fatalities recorded in just the first half of 2025.
The urgency is sharpened by the disease's trajectory. About one in five MASLD cases progress to MASH, an aggressive inflammatory form that can lead to cirrhosis and liver cancer. For years, widespread screening seemed difficult to justify without a treatment to offer. The recent approval of the first MASH medication changes that calculus entirely.
The researchers point to steps that are concrete and achievable: add liver blood tests to existing diabetes care programs, expand non-invasive diagnostics through the public health system, and integrate liver risk assessment into ENSANUT, Mexico's national health and nutrition survey, which already collects much of the relevant underlying data. The infrastructure and the numbers are already there. What the country needs now is the will to connect them.
Mexico is sitting on a public health crisis it barely acknowledges. Nearly half of the country's adults carry a liver disease linked directly to obesity and diabetes—two conditions the nation has been tracking and treating for years. Yet liver disease itself remains largely invisible in Mexico's health surveillance systems, a blind spot that costs lives and squanders the chance to catch the problem early.
This disconnect is the focus of a new paper by Jeffrey Lazarus, a professor at the CUNY Graduate School of Public Health and Health Policy, and his colleagues. Their work, published in Archives of Medical Research and timed to coincide with the International Congress on Obesity meeting in Mexico City this week, makes a straightforward argument: Mexico should stop treating liver disease as a separate problem and fold it into the existing infrastructure built to manage diabetes, obesity, and other chronic conditions.
The numbers are stark. A screening study across five Mexican states found that 47 percent of participants met the criteria for metabolic dysfunction-associated steatotic liver disease, or MASLD—a condition where fat accumulates in the liver alongside the cardiometabolic risk factors that define modern illness. Obesity affects an estimated 39 percent of Mexican adults; type 2 diabetes affects 16.4 percent. These diseases cluster together, feed each other, and now liver disease has become the leading cause of cirrhosis at Mexican referral centers, accounting for 42.8 percent of cases between 2018 and 2024. The human toll is already visible: liver disease ranks as Mexico's fifth leading cause of death, with more than 19,000 deaths recorded in just the first half of 2025.
What makes this particularly urgent is the natural history of the disease itself. About one in five people with MASLD develop a more aggressive inflammatory form called MASH, which can progress to cirrhosis and liver cancer. For years, there was little point in screening for a condition you couldn't treat. That changed recently with the arrival of the first approved medication for MASH, which means early detection now has real clinical consequence.
Lazarus and his team point to concrete, achievable steps. Mexico could add simple blood-based liver screening to the diabetes and obesity care programs already in place. The country could expand access to non-invasive diagnostic tools through the public health system. And it could integrate liver risk assessment into ENSANUT, Mexico's national health and nutrition survey, which already collects much of the underlying data but does not currently evaluate liver health.
The core insight is that treating these diseases in isolation—diabetes in one clinic, obesity in another, liver disease nowhere—misses the chance to build a more coherent and effective response. Prevention, early diagnosis, and equitable care all depend on seeing the patient as a whole, not as a collection of separate problems. Mexico has the infrastructure and the data. What it needs now is the will to connect them.
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Treating these diseases separately misses a major opportunity to define and implement a much more cohesive and effective public health response that improves prevention, early diagnosis, and equitable care.— Jeffrey Lazarus, CUNY Graduate School of Public Health and Health Policy
A Conversa do Hearth Outra perspectiva sobre a história
Why hasn't Mexico been tracking liver disease if it's already the fifth leading cause of death?
Because it wasn't always seen as a distinct public health problem. Diabetes and obesity were the visible epidemics. Liver disease was something that happened to people with those conditions, but nobody was measuring it systematically. It was invisible in the data.
But the screening study found 47 percent of people had this condition. That's enormous.
It is. And that's the point—once you actually look, you find it everywhere. But you have to look. Mexico wasn't looking.
What changes now that there's a treatment?
Everything. Before, screening someone for MASH was almost cruel—you'd tell them they had a serious liver disease and then say there's nothing we can do. Now you can actually offer something. That makes early detection worth doing.
Is this just about adding one more blood test to existing appointments?
It sounds simple, but it's not trivial. It means changing how clinics work, training staff, integrating data systems. But yes, the actual screening part is straightforward. The hard part is building it into the routine.
Why does the paper emphasize integration rather than creating a separate liver disease program?
Because these diseases are metabolically linked. Someone with obesity and diabetes is at high risk for liver disease. If you're already seeing them for one condition, you're already in the room. You might as well check the liver while you're there. Separate programs mean separate appointments, separate data, separate budgets. Integration is more efficient and catches more people.
What happens if Mexico doesn't do this?
The death toll continues. More people develop cirrhosis and liver cancer. And you miss the window when intervention could have prevented progression. Once someone has advanced liver disease, the options narrow fast.