At this year's RCN Congress I will be discussing my work as an Hepatology Advanced Nurse Practitioner. When most people hear the words “liver disease,” they usually think of alcohol. It’s a common assumption and, honestly, an understandable one. But it’s also one of the biggest myths stopping people from recognising their risk and getting help early enough.

The reality is far more complex. There are more than 18 different causes of liver disease, and alcohol is only one of them. Someone can drink very little, or not drink at all, and still develop serious liver disease. At the same time, a person who does drink alcohol may also have another underlying cause affecting their liver. It’s rarely as simple as people think and that’s exactly why early detection matters so much.

Liver disease is now one of the fastest rising causes of premature death in the UK. It’s currently the third biggest cause of early mortality and, alarmingly, it’s the only major disease where death rates are still increasing. Over the last 50 years, deaths from liver disease have quadrupled.

Yet despite those numbers, it’s still not something we talk about nearly enough. Part of the reason is because liver disease is often silent. The liver is remarkably resilient and can continue functioning even when it’s under significant strain. Most people don’t feel unwell until the disease has already progressed. Symptoms such as jaundice, abdominal swelling, or severe fatigue often appear much later, when damage may already be irreversible. That’s why around 75% of people are diagnosed too late.

The misconception that liver disease is only linked to alcohol has created a dangerous gap in awareness. Yes, alcohol can damage the liver, but it’s only one part of a much bigger picture. Liver disease can also develop because of metabolic conditions, viral hepatitis, autoimmune diseases, genetic conditions, cholestatic diseases, medication related injury, and many other causes.
So when someone says, “I don’t drink, so I’m fine,” that simply isn’t always true. And equally, when someone does drink alcohol, it doesn’t automatically mean alcohol is the only explanation. Many people have overlapping risk factors, and every possible cause needs to be properly investigated.

One area receiving increasing attention is fatty liver disease, which has recently been renamed to better reflect what actually drives it.You may now hear the terms MAFLD, which stands for Metabolic Dysfunction Associated Fatty Liver Disease, or MASLD, Metabolic Dysfunction Associated Steatotic Liver Disease, which refers to a more aggressive form of the condition.

What’s important to understand is that these are diagnoses of exclusion. In other words, doctors should rule out all other causes of liver disease before confirming MAFLD or MASLD. That matters because treatment only works properly when the full picture is understood. For example, someone may have metabolic risk factors such as high cholesterol, insulin resistance, type 2 diabetes, or weight related health issues. Those absolutely need to be addressed. But if that same person also has mild alcohol related liver injury or an underlying genetic condition, those factors need attention too. It’s rarely just one thing causing liver disease.

The encouraging part in all of this is that early detection can genuinely change lives. Around 90% of liver disease cases are preventable or reversible if identified early enough. That’s an incredible statistic, especially for a condition that often flies under the radar. Simple lifestyle changes, earlier intervention, and the right medical support can dramatically reduce long term damage.
But waiting for symptoms is risky because, by the time symptoms appear, the liver may already be struggling badly.

Early action gives people the chance to prevent cirrhosis, reduce their risk of liver cancer and protect both their quality of life and life expectancy. That’s why awareness matters so much. Liver disease does not discriminate in the way many people assume it does.

The bottom line is this: liver disease is not simply an “alcohol problem.” It’s a complex medical condition with many different causes, and it’s affecting more people, at younger ages, than ever before. Understanding the full range of causes, investigating all possible contributing factors, and taking metabolic health seriously are essential steps in protecting liver health. Because when it comes to liver disease, early detection is not just helpful. It can be lifesaving.