A free 2-minute risk check, then two blood draws a year at a lab near you. Every result is reviewed by a clinician and comes with your stage, what it means, and what to do next.
Living with type 2 diabetes? Liver scarring is common with diabetes and rarely causes symptoms. A blood test can check.
Why check
Fatty liver is common. Scarring rarely causes symptoms.
28.7%of US adults have fatty liver on a liver scan
2.4%say a doctor has told them they have it
1 in 6adults with type 2 diabetes has moderate liver scarring or worse
Sources: Unalp-Arida and Ruhl, Hepatology 2025; Lomonaco et al., Diabetes Care 2021.
Why it matters
Scarring is what drives risk. It can also improve.
Fat in the liver is common and often mild on its own. Scarring is different: each stage raises the risk of cirrhosis, liver cancer and early death. However, fat, inflammation and even scarring can improve when the cause is treated.
Scarring predicts the future. Of everything a liver biopsy shows, the stage of scarring best predicts long-term health.
The heart is at risk too. Heart disease is the most common cause of death in people with fatty liver, ahead of liver disease.
Cirrhosis and liver cancer. Advanced scarring can lead to both. Fatty liver disease was behind 1 in 5 US liver transplants in 2023.
Risk of dying from liver disease, by stage of scarring
Compared with people who have no scarring. 1,495 adults, pooled from 5 studies.
See the numbers
Stage
Relative risk
F0 (none)
1x
F1 (mild)
1.4x
F2 (moderate)
9.6x
F3 (advanced)
16.7x
F4 (cirrhosis)
42.3x
Source: Dulai et al., Hepatology 2017.
It can improve
How much weight loss helps the liver
5%of body weightLess liver fatFat in the liver starts to fall.
7 to 10%of body weightLess inflammationInflammation, the step before scarring, improves.
10%+of body weightLess scarringScarring can improve. In one study, 45% of people who lost 10% or more over a year saw it improve.
Targets from the EASL-EASD-EASO guideline, 2024. Study: Vilar-Gomez et al., Gastroenterology 2015.
Medicines help too
In trials of the two medicines approved for moderate to advanced scarring, scarring improved in 24% to 37% of people, compared with 14% to 22% on placebo. Scarring that improves is linked to fewer liver complications later.
Sources: AASLD Practice Guidance 2023; EASL-EASD-EASO guideline 2024; Dulai et al., Hepatology 2017; OPTN/SRTR 2023 Annual Data Report; Vilar-Gomez et al., Gastroenterology 2015; Harrison et al., NEJM 2024; Sanyal et al., NEJM 2025. Full references.
The difference
Lab tests stop at a number. LiverStage gives the answer.
You can already buy a liver blood test online. What comes back is a score with no stage, no specialist and no plan. LiverStage connects the test to the decision.
The answer comes first
Your stage, what it means, and the next step, in plain language.
Every result leads somewhere
A recheck, a scan, a specialist, or a treatment path.
A clinician reviews every result
Under protocols written by liver specialists. We say so on every report.
Usually
With LiverStage
Who starts testing
A specialist referral
You, from wherever you manage your health
First signal
Liver enzymes, often normal
FIB-4 and SAFE, from labs you already have
Second step
A scan at a specialist office
A blood test for every member
The result
A number
A stage, a likely cause and a next step
Treatment
A specialist visit and paperwork
A televisit with the documentation built in
Follow-up
Repeat imaging, if it happens
Repeat draws that show change
How it works
A stage, a specialist and a path to treatment.
01
Free risk check
Six questions, and your past labs if you connect your records.
02
Your draw
At a lab near you. Six tests, with ELF for every member.
03
The answer
Your stage and next step, reviewed by a clinician.
04
Specialist
A televisit and the paperwork, when your result calls for it.
Most liver checks stop at FIB-4, which can miss scarring. Every LiverStage member also gets ELF, a blood test many plans accept as evidence of the stage.
One stage. One next step. Reviewed by a clinician.
Your history, connected
Your past labs show where your liver has been.
Most people already have years of routine blood work in a patient portal. Connect your records and we calculate FIB-4 and SAFE from every past panel, so your first report shows a trend, not a single point.
Connect in a few minutes
Sign in to your health system's patient portal through a secure connection and approve sharing. You choose each source.
A trend from day one
Past panels become past scores, so change shows up at your first draw instead of your third.
Context for every change
Weight, A1c and when you started a medicine sit next to your liver scores, so you and your clinician can see what moved them.
Wearables, if you like
Add activity and weight from your devices and watch how your routine shows up in your liver.
You can disconnect at any time. Records are used for your care; research use needs a separate consent. How connecting works.
Example member
FIB-4 over seven years
Five years of past labs showed a rise nobody flagged. After a GLP-1 started, LiverStage draws show the score coming back down.
Past labs, from your recordsLiverStage drawsMedicine started
See the numbers
Date
FIB-4
Source
Mar 2021
1.18
From records: annual physical
Feb 2022
1.31
From records: annual physical
Apr 2023
1.46
From records: annual physical
May 2024
1.63
From records: annual physical
Jul 2025
1.79
From records: annual physical
May 2026
1.92
From records: diabetes visit
Feb 2027
1.74
LiverStage enrollment draw, ELF 9.4
Aug 2027
1.52
LiverStage month-6 recheck
Feb 2028
1.36
LiverStage annual draw
Example values for illustration, not a real member.
Add the alcohol module (PEth) to either plan for $99. Pre-orders are fully refundable.
Care and coverage
Treatment may be covered when your stage is documented.
Some plans cover medicine for liver scarring when the stage is documented with an accepted test and a specialist writes the prescription. When your result is consistent with F2-F3, we set up the specialist visit and prepare that documentation.
Hepatology televisit
With a liver or obesity-medicine specialist. Billed to your insurance, or $149.
Prior authorization packet
Your results within the plan's time window and the specialist's note, ready to send.
Your choice of prescriber
Your own clinician, our specialist, or the manufacturer's pharmacy. We stay neutral on which treatment.
Example · Prior authorization packet Ready to send
Stage documented with an accepted test
ELF 9.8, drawn 12 Feb 2027. Inside the plan's 6-month window.
FIB-4 2.14 and SAFE 112, supporting scores.
Specialist note from your hepatology televisit.
Plan criteria checked against your policy.
Coverage depends on your plan. LiverStage prepares the documentation; your plan makes the decision.
Research
One extra tube for research, only if you say yes.
At the same visit, you can give one extra tube of blood for liver research. It is stored under a separate consent. Saying no changes nothing about your membership.
LiverStage gives a stage estimate from blood tests that plans accept, reviewed by a clinician. When your result calls for it, we connect you with a liver specialist who can confirm it.
Will my plan cover treatment?
It may. Some plans cover medicine for liver scarring when the stage is documented with an accepted test and a specialist writes the prescription. We prepare that documentation. Coverage depends on your plan.
Who reviews my result?
A licensed clinician reviews every result, under protocols written by liver specialists (hepatologists).
Where is LiverStage available?
LiverStage starts in about 20 states. The risk check asks for your state and tells you whether we are there yet.
Know where your liver stands, and whether it is improving.
LiverStage is a membership built around two blood draws a year. Here is what happens at each step, and who does it.
01
Free risk check
Answer six questions about your age, weight, diabetes, GLP-1 use, alcohol and any past liver findings. If you connect your health records, we calculate FIB-4 and SAFE from labs you already have.
About 2 minutes
Records connect only with your permission
An educational result, not a diagnosis
02
Join
Choose Base or Plus. An independent physician reviews your request and orders your tests, so you do not need a visit with your own doctor first.
Base $249 or Plus $299 a year
Pre-orders are fully refundable
Add the alcohol module for $99
03
Your first draw
Book a visit at a patient service center near you. One draw covers the full panel: CMP, CBC, lipid panel, A1c, GGT and ELF.
A research tube, only if you say yes
Plus: your genetic panel sample, at the same visit
PEth, if you added the alcohol module
04
Your answer
Your scores are read together with ELF under rules set by liver specialists. A licensed clinician reviews every result before you see it, and explains it in plain language.
Your stage and what it means
A next step for every result
Questions go to our care team
05
Your next step
What happens next depends on your result: a routine recheck, a repeat ELF, a liver scan at a partner site, or a specialist televisit.
A liver scan only when it is needed
Televisit billed to insurance, or $149
06
A path to treatment
When your result is consistent with F2-F3, we prepare the prior authorization packet your plan asks for. Your prescription can come from your own clinician, our specialist, or the manufacturer's pharmacy.
Tests inside the plan's time window
The specialist's note included
Neutral on which treatment
07
Recheck and renewal
Your month-6 draw shows what is changing. Your annual draw, about 12 months after the first, renews your membership and your documentation.
Month 6: a lighter recheck
Month 12: the full panel again
A trend you can follow
Your records
Connect your past labs in a few minutes.
Your routine blood work already holds most of what FIB-4 and SAFE need. Connecting it gives your liver a history before your first draw, and makes every later change easier to see.
Step 1
Pick your health systems
Search for the hospitals, clinics and labs where you have had blood work.
Step 2
Sign in and approve
Sign in to each patient portal and approve sharing. You choose each source.
Step 3
See your trend
We bring in past labs, weight and medicines, calculate your past liver scores and show how they have moved.
Earlier signal
A score that has been rising for years gets a closer look at your first draw, not your third.
The why behind a change
Weight, A1c and medicine start dates line up with your liver scores, so you and your clinician can see what is working.
Your devices, if you like
Activity and weight from wearables and smart scales can join the same view.
Yours to control
Disconnect at any time. Records are used for your care; research use needs a separate consent.
Example member
FIB-4 over seven years
Five years of past labs showed a rise nobody flagged. After a GLP-1 started, LiverStage draws show the score coming back down.
Past labs, from your recordsLiverStage drawsMedicine started
See the numbers
Date
FIB-4
Source
Mar 2021
1.18
From records: annual physical
Feb 2022
1.31
From records: annual physical
Apr 2023
1.46
From records: annual physical
May 2024
1.63
From records: annual physical
Jul 2025
1.79
From records: annual physical
May 2026
1.92
From records: diabetes visit
Feb 2027
1.74
LiverStage enrollment draw, ELF 9.4
Aug 2027
1.52
LiverStage month-6 recheck
Feb 2028
1.36
LiverStage annual draw
Example values for illustration, not a real member.
Your year
Two draws a year show whether your liver is improving.
Month 0
Enrollment
The full panel and your first answer.
CMPCBCLipidsA1cGGTELF
Month 6
Recheck
A lighter draw. ELF repeats when your results flag a change.
CMPCBCGGTELF if flagged
Month 12
Renewal
The full panel again, and updated documentation for your plan.
CMPCBCLipidsA1cGGTELF
Your care team
Liver specialists set the rules. A clinician reads every result.
Liver specialists
Hepatologists write the protocols that set every result tier and next step.
Reviewing clinicians
A licensed clinician reviews every result before you see it.
Specialist televisits
Liver and obesity-medicine specialists, through our hepatology partner.
Partner labs
Your blood is drawn at a patient service center near you.
Where LiverStage is available
LiverStage starts in about 20 states in 2027 and adds more through the year. New York, New Jersey, Rhode Island and Maryland have extra rules for direct lab testing and come later. The risk check asks for your state and tells you whether we are there yet.
Every membership draw runs the same core panel, so your results can be compared over time. Here is what each test measures and why it is there.
In every draw
The lab tests
CMP
Metabolic panel
Liver enzymes (AST and ALT), albumin, total protein and glucose. The enzymes and proteins feed every liver score.
EnrollmentMonth 6Annual
CBC
Blood count
Your platelet count, which tends to fall as scarring becomes advanced. Every liver score uses it.
EnrollmentMonth 6Annual
Lipid panel
Cholesterol
Cholesterol and triglycerides, which track the metabolic health behind most fatty liver.
EnrollmentAnnual
Hemoglobin A1c
Blood sugar
Your average blood sugar over about 3 months. Diabetes is one of the strongest risk factors for liver scarring.
EnrollmentAnnual
GGT
Liver enzyme
A liver enzyme that rises with fatty liver and with regular drinking. It is not part of the standard metabolic panel, so we add it.
EnrollmentMonth 6Annual
ELF
Enhanced Liver Fibrosis
Three markers of scar tissue being made and broken down in the liver (hyaluronic acid, PIIINP and TIMP-1). Many plans accept ELF as evidence of the stage.
EnrollmentAnnualMonth 6 if flagged
Why every member gets ELF
Many services run ELF only when FIB-4 is 1.3 or higher. FIB-4 can read low in people who already have scarring, so every LiverStage member gets ELF at enrollment and every year after.
Calculated from the same draw
The liver scores
Each score is a formula doctors already use. They cost nothing extra, because every input is already in your panel or your answers.
FIB-4
Fibrosis-4 index
The most widely used first check for liver scarring, calculated from your age, two liver enzymes and your platelet count.
AgeASTALTPlatelets
Below 1.3 Low1.3 to 2.67 UnclearAbove 2.67 High
Less reliable under 35. From age 65, the low cut-off moves to 2.0.
SAFE
Steatosis-Associated Fibrosis Estimator
A newer score, published in 2023, that adds weight, diabetes and blood proteins to the FIB-4 inputs. In published comparisons it has outperformed FIB-4 at spotting moderate scarring.
AgeBMIDiabetesASTALTGlobulinPlatelets
Below 0 Low0 to 99 Unclear100 or more High
NFS
NAFLD fibrosis score
An established score that adds BMI, blood sugar and albumin. It gives a second view when FIB-4 is borderline.
AgeBMIBlood sugarASTALTPlateletsAlbumin
Below -1.455 Low-1.455 to 0.676 UnclearAbove 0.676 High
APRI
AST to platelet ratio index
A simple ratio of one liver enzyme to your platelet count, used as a check on the others.
ASTPlatelets
Below 0.5 Low0.5 to 1.5 UnclearAbove 1.5 High
No single score decides your result. Your clinician sees all four together with ELF. Want to try FIB-4 and SAFE on labs you already have? Use the calculator.
When you need more
Add-ons and next steps
Alcohol module
PEth · $99
Phosphatidylethanol (PEth) forms in red blood cells only when you drink, and reflects roughly the past 2 to 4 weeks. Paired with your liver results, it shows how your liver is handling what you drink.
Some common gene variants raise the chance that fatty liver leads to scarring, and some lower it. Plus includes a multi-gene liver risk panel, run once in a CLIA-certified lab.
Genetic results describe risk, never a diagnosis. The panel needs its own consent.
Liver scan
Only when needed
When a plan requires a scan for coverage, or your blood results are unclear, we arrange elastography at a partner imaging site, billed to your insurance.
Your report leads with the answer: your stage, what it means, and the next step. The numbers are there too, in plain view. Choose a result to see an example report.
Example report Consistent with F2-F3
Your results suggest moderate liver scarring. A specialist visit is the next step.
Low riskCloser lookF2-F3Possible cirrhosis
FIB-42.14
SAFE112
ELF9.8
Hepatology televisit, billed to insurance or $149
Prior authorization documentation, prepared for you
Recheck in 6 months
Reviewed by a licensed clinician · 2 Mar 2027 · Example values
What this means
F2 and F3 mean moderate to advanced scarring, without cirrhosis. It is the stage where current medicines for liver scarring are approved, and the stage many plans ask to see documented before they cover treatment.
How we reached it
Your four scores and ELF are read together under rules set by liver specialists. When they disagree, your result says so, and the next step settles it.
What stays the same
Every report shows the same scores in the same order, so you can compare one draw to the next.
Stages
What a stage means
Doctors grade liver scarring from F0 to F4. Scarring can improve when its cause is treated, which is why your draws repeat.
F0No scarring
F1Mild
F2Moderate
F3Advanced
F4Cirrhosis
Where current medicines are approved, and what many plans ask to see documented
Reviewed by a clinician
Every result, before you see it. We say so on every report.
A next step, every time
Low risk included: your next draw is already on the calendar.
Change over time
Each draw adds a point to your trend, so you can see whether your liver is improving.
Order in about 2 minutes, or start with the free risk check. Pre-orders are fully refundable, and membership begins when LiverStage opens in your state.
Compare
Base and Plus, side by side
What you get
Base
Plus
Free risk check
Yes
Yes
Two draws a year, with ELF for every member
Yes
Yes
FIB-4, SAFE, NFS and APRI, read together
Yes
Yes
Clinician review of every result
Yes
Yes
Specialist televisit, prior authorization packet, liver scan when a plan requires one
Yes
Yes
Research studies you can join
Yes
Yes, with priority for gene-matched studies
Multi-gene liver risk panel, run once in a CLIA-certified lab
Not included
Yes
Genetic risk in every report, and family guidance
Not included
Yes
Alcohol module (PEth)
$99 add-on
$99 add-on
Price
$249 a year
$299 a year
What you pay
What your membership covers, and what insurance may cover
Your draws
Lab tests, clinician review and documentation are part of your membership. There is no separate lab bill.
Specialist visits
Billed to your insurance. Without coverage, a televisit is $149.
Liver scans
Arranged only when needed, at a partner imaging site, billed to your insurance.
Treatment
May be covered by your plan when your stage is documented. We prepare the paperwork; your plan decides.
Plus
What the genetic panel adds
Some common gene variants raise the chance that fatty liver leads to scarring, and some lower it. How common they are varies by ancestry. The Plus panel looks at several of these genes at once, in a CLIA-certified lab, and your results help your clinician read your other scores.
Run once, from your first draw
No extra visit. The sample is taken at the same appointment.
Risk, never a diagnosis
A variant raises or lowers risk. Your stage still comes from your blood tests.
Its own consent
Plus asks for a separate genetic consent. You can ask us to destroy your sample and genetic data at any time.
Every result reviewed by a clinician Drawn at a lab near you
Example result Consistent with F2-F3
Your results suggest moderate liver scarring. A specialist visit is the next step.
Low riskCloser lookF2-F3Possible cirrhosis
FIB-42.14
ELF9.8
Reviewed2 Mar 2027
Hepatology televisit, billed to insurance or $149
Prior authorization documentation, prepared for you
Recheck in 6 months
Why it matters
Your liver stage can change what your plan covers.
Your stage can open coverage
One GLP-1 medicine is approved for liver scarring at the F2 to F3 stage. Some plans that do not cover GLP-1s for weight loss may cover one for liver scarring, when the stage is documented.
Scarring rarely causes symptoms
Liver scarring rarely causes symptoms, and liver enzymes are often normal. A blood test built for scarring is the way to know.
Repeat checks show the response
Your month-6 and annual draws show how your liver is responding. Some plans ask for that evidence at renewal.
Works with your GLP-1
Keep your prescription where it is.
LiverStage works alongside whoever prescribes your GLP-1: your own doctor, an online program or the manufacturer's pharmacy. We supply the liver answer and the documentation.
I get my GLP-1 online. Can I still use LiverStage?
Yes. Your blood is drawn at a lab near you, and your result and documentation can go to whoever prescribes for you.
Does LiverStage prescribe GLP-1s?
LiverStage does not sell medicines. When your result calls for treatment, a liver specialist can prescribe through a televisit, or your own clinician can use our documentation.
My plan asks for a liver scan. Can you arrange one?
Yes. Some plans ask for a scan instead of a blood test. When yours does, we arrange elastography at a partner imaging site, billed to your insurance.
Will my plan cover treatment?
It may. Coverage depends on your plan's written criteria. We prepare the documentation those criteria ask for; your plan makes the decision.
Told you have fatty liver? Find out if it has caused scarring.
Fatty liver is common. Scarring is what matters. LiverStage tells you which you have, with a blood test at a lab near you and an answer reviewed by a clinician.
An ultrasound can show fat. It cannot reliably show scarring.
Ultrasound
LiverStage
Fat in the liver
Yes
From records
Stage of scarring
No
Yes
Next step
No
Yes
Change over time
Rarely repeated
Twice a year
What to know
Fatty liver is common. Scarring is what matters.
28.7%
of US adults have fatty liver on a liver scan
Most never develop serious scarring. The ones who do rarely feel it.
A scan shows fat, not scarring
An ultrasound or CT can show fat in the liver. It cannot reliably show how much scarring there is.
Normal enzymes are not the all-clear
Liver enzymes are often normal in people with scarring. Tests built for scarring give a clearer picture.
Source: Unalp-Arida and Ruhl, Hepatology 2025.
What you can do
Scarring can improve.
When its cause is treated, liver scarring often stops progressing and can improve. Losing about 5% of your weight lowers liver fat, 7 to 10% calms inflammation, and 10% or more can improve scarring. Managing diabetes and drinking less help too, and medicines are approved for moderate to advanced scarring. Your draws show whether it is working.
My doctor said fatty liver is nothing to worry about. Should I check?
For many people it is mild. A LiverStage result tells you whether yours has caused scarring, which is the part that matters for your long-term health.
Do I need a referral?
No. An independent physician reviews your request and orders your tests.
I have hepatitis or another liver condition. Is LiverStage for me?
LiverStage is built for fatty liver and alcohol-related liver disease. If you have hepatitis B or C or another known liver condition, your own liver specialist is the right place for care.
Find out how your liver is handling what you drink.
There is no single safe number. How alcohol affects your liver depends on you. LiverStage measures what you drink and how your liver is responding, and tells you plainly.
Regular drinking. Your PEth shows regular drinking over the past few weeks. Your liver scores and ELF are in the low-risk range, so your liver is handling it for now.
GGT48 U/L
FIB-41.12
ELF8.9
Bands: under 20 light or no drinking; 20 to 200 regular drinking; over 200 heavy drinking.
54%of US adults drink alcohol
53%say moderate drinking is bad for your health
Source: Gallup, August 2025.
The alcohol module
A measure, your liver's response, and plain advice.
An objective measure
PEth forms only when you drink and reflects roughly the past 2 to 4 weeks. It does not depend on remembering.
Your liver's response
Your liver scores, GGT and ELF show how your liver is responding to what PEth measures.
Advice, not judgment
We report and advise. If you want support, we connect you with an alcohol care partner.
The alcohol module adds $99 to Base or Plus, at any membership draw.
Questions
About the alcohol module
Will anyone else see my PEth result?
Your results are shared with the clinicians caring for you. Anyone else sees them only with your permission.
Do I have to stop drinking?
No one will tell you what to do. Your result shows how your liver is handling your current drinking, and your clinician can talk through options if you want.
How far back does PEth measure?
Roughly 2 to 4 weeks, depending on how much and how often you drink.
What if my liver shows alcohol-related injury?
Your result is flagged as alcohol-related injury, with support from an alcohol care partner and a liver specialist when scarring is present.
What the research and the liver guidelines say helps fatty liver, and what does not. Use it to plan with your clinician.
Weight
Weight loss is the most reliable lever.
Guidelines set targets by the share of body weight you lose and keep off. More weight loss helps more of the liver.2
90% and 45%of people who lost 10% or more saw inflammation clear and scarring improve, in a year-long study of 293 adults with biopsies before and after.5
Few people get there alone. Even with structured help, 10% or fewer reach that weight loss at one year, and fewer than half of them keep it off at five years.1 See programs below.
5%of body weightLess liver fatFat in the liver starts to fall.
7 to 10%of body weightLess inflammationInflammation, the step before scarring, improves.
10%+of body weightLess scarringScarring can improve. In one study, 45% of people who lost 10% or more over a year saw it improve.
Targets from the EASL-EASD-EASO guideline, 2024. Study: Vilar-Gomez et al., Gastroenterology 2015.
Diet
What to eat
The pattern of your diet matters, and so does eating less of it. The method you use to cut calories matters less.
A Mediterranean-style diet
Vegetables, legumes, whole grains, fish, olive oil and nuts, with less red meat and refined carbohydrate. US and European liver guidelines both recommend this pattern.12
39% vs 7%drop in liver fat on a Mediterranean diet vs a low-fat diet over 6 weeks, without weight loss, in a small crossover trial of 12 people.8
Fewer ultra-processed foods, no sugary drinks
European guidelines advise limiting ultra-processed food and avoiding sugar-sweetened drinks.2 Too much fructose, the sugar in many sweetened drinks, raises the risk of fatty liver, inflammation and scarring whatever your calorie intake.1
Cut calories in the way that suits you
Low-carb, low-fat, intermittent fasting and Mediterranean plans work about equally well when calories fall.1 Choose the one you can keep up.
Similar results5:2 fasting and a low-carb diet each lowered liver fat more than standard advice over 12 weeks.9 Eating within an 8-hour window worked as well as calorie counting over 12 months.10
Coffee, 3 or more cups a day
US guidance says 3 or more cups a day could be recommended if you have no reason to avoid it.1
44% lowerrisk of cirrhosis for each extra 2 cups a day, across observational studies of 432,133 people.11
Alcohol: less is better, none with scarring
With moderate scarring (F2) or more, stop drinking completely.1 European guidelines discourage alcohol for everyone with fatty liver, and find no protective effect from light or moderate drinking.2
Diet changes are proven to improve liver fat and liver tests. There is less evidence so far that diet alone prevents long-term liver complications.2 That is one reason your draws repeat.
Exercise
Move 150 minutes a week
Aim for at least 150 minutes of moderate activity, such as brisk walking, or 75 minutes of vigorous activity a week.2 Exercise helps your liver even when your weight does not change.1
The dose that works
Across 14 trials, people who reached about 150 minutes a week of brisk walking, or the equivalent, were far more likely to cut their liver fat by 30% or more, the drop linked to real improvement in the liver.
3.7xhigher odds of that drop at 750 MET-minutes a week, without more than 5% weight loss.12
Strength training counts
Resistance exercise lowered liver fat with no change in weight in a small 8-week trial.13
13%drop in liver fat after 8 weeks of resistance exercise.
Intervals or steady effort: both work
High-intensity intervals and steady moderate exercise lowered liver fat by similar amounts across 19 trials of 745 people.14 Pick the one you will keep doing.
An example week
MonBrisk walk30 min
TueStrength30 min
WedBrisk walk30 min
ThuRest or stretch
FriBrisk walk30 min
SatStrength, then walk25 + 20 min
SunIntervals or a long walk40 min
About 150 minutes of walking or intervals and two strength sessions. An example, not a prescription. If you have heart disease or another condition, check with your clinician before you start.
Supplements
What the evidence says about supplements
No supplement replaces weight loss and exercise. One has trial evidence, with real risks. Talk to your clinician before you start any of them.
Vitamin E
Only if advised
In adults without diabetes whose liver inflammation was confirmed by biopsy, 800 IU a day improved inflammation in 43% vs 19% on placebo over 96 weeks.15 US guidance says it can be considered in select people; European guidelines do not recommend it as a treatment.12 High doses may raise the risk of bleeding, including bleeding in the brain, and data on prostate cancer conflict, so take it only if your liver specialist advises it.1
Omega-3 fish oil
Not a liver treatment
No liver-specific benefit in US guidance. It remains an option for high triglycerides.1
Milk thistle (silymarin)
Not recommended
US guidance says it should not be used to treat liver inflammation, because it does not offer a meaningful benefit.1
Probiotics, vitamin D, berberine and similar
Evidence too thin
European guidelines find too little evidence that these products work for fatty liver, or that they are safe.2
Use caution
Some supplements can harm the liver.
Herbal and dietary supplements are a growing cause of liver injury in the US. Tell your care team about everything you take, including teas, powders and bodybuilding products.
7% to 20%Rise in the share of drug-induced liver injury cases caused by herbal and dietary supplements in a US research network, 2004 to 2013.16
15.6 millionUS adults who used at least one of six botanicals linked to liver injury in the past 30 days: turmeric, green tea extract, ashwagandha, garcinia cambogia, red yeast rice and black cohosh.17
Programs
Structured programs help more people get there.
Weekly group or coaching sessions, a daily calorie goal and an activity target help more people reach and keep a 10% weight loss. US guidance recommends team care with dietitians and behavioral specialists when possible.1 Ask your care team about programs near you or covered by your plan.
9.3% vs 0.2%Average weight loss at 48 weeks in a program modeled on the Diabetes Prevention Program, compared with education alone. 40% of participants lost 10% or more.18
When lifestyle is not enough
Medicines are approved for moderate to advanced scarring (F2 to F3). Your LiverStage result shows whether you are in that range, and a specialist can talk through the options.
Guidelines and studies cited on this site. Educational content, not medical advice for your situation.
Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835. doi.org/10.1097/HEP.0000000000000323
Tacke F, Horn P, Wong VW, et al. EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. doi.org/10.1016/j.jhep.2024.04.031
Dulai PS, Singh S, Patel J, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017;65(5):1557-1565. doi.org/10.1002/hep.29085
Kwong AJ, Kim WR, Lake JR, et al. OPTN/SRTR 2023 Annual Data Report: Liver. Am J Transplant. 2025;25(2 Suppl):S193-S287. doi.org/10.1016/j.ajt.2025.01.022
Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367-378. doi.org/10.1053/j.gastro.2015.04.005
Harrison SA, Bedossa P, Guy CD, et al. A phase 3, randomized, controlled trial of resmetirom in NASH with liver fibrosis. N Engl J Med. 2024;390(6):497-509. doi.org/10.1056/NEJMoa2309000
Sanyal AJ, Newsome PN, Kliers I, et al. Phase 3 trial of semaglutide in metabolic dysfunction-associated steatohepatitis. N Engl J Med. 2025;392(21):2089-2099. doi.org/10.1056/NEJMoa2413258
Ryan MC, Itsiopoulos C, Thodis T, et al. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol. 2013;59(1):138-143. doi.org/10.1016/j.jhep.2013.02.012
Holmer M, Lindqvist C, Petersson S, et al. Treatment of NAFLD with intermittent calorie restriction or low-carb high-fat diet: a randomised controlled trial. JHEP Rep. 2021;3(3):100256. doi.org/10.1016/j.jhepr.2021.100256
Wei X, Lin B, Huang Y, et al. Effects of time-restricted eating on nonalcoholic fatty liver disease. JAMA Netw Open. 2023;6(3):e233513. doi.org/10.1001/jamanetworkopen.2023.3513
Kennedy O, Roderick PJ, Buchanan R, et al. Systematic review with meta-analysis: coffee consumption and the risk of cirrhosis. Aliment Pharmacol Ther. 2016;43(5):562-574. doi.org/10.1111/apt.13523
Stine JG, DiJoseph K, Pattison Z, et al. Exercise training is associated with treatment response in liver fat content by magnetic resonance imaging independent of clinically significant body weight loss in patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis. Am J Gastroenterol. 2023;118(7):1204-1213. doi.org/10.14309/ajg.0000000000002098
Hallsworth K, Fattakhova G, Hollingsworth KG, et al. Resistance exercise reduces liver fat and its mediators in non-alcoholic fatty liver disease independent of weight loss. Gut. 2011;60(9):1278-1283. doi.org/10.1136/gut.2011.242073
Sabag A, Barr L, Armour M, et al. The effect of high-intensity interval training vs moderate-intensity continuous training on liver fat: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2022;107(3):862-881. doi.org/10.1210/clinem/dgab795
Sanyal AJ, Chalasani N, Kowdley KV, et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010;362(18):1675-1685. doi.org/10.1056/NEJMoa0907929
Navarro VJ, Barnhart HX, Bonkovsky HL, et al. Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. Hepatology. 2014;60(4):1399-1408. doi.org/10.1002/hep.27317
Likhitsup A, Chen VL, Fontana RJ, et al. Estimated exposure to 6 potentially hepatotoxic botanicals in US adults. JAMA Netw Open. 2024;7(8):e2425822. doi.org/10.1001/jamanetworkopen.2024.25822
Promrat K, Kleiner DE, Niemeier HM, et al. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology. 2010;51(1):121-129. doi.org/10.1002/hep.23276
Answers to what people ask most, grouped by topic.
About LiverStage
What is LiverStage?
A liver health membership. It starts with a free risk check, adds two blood draws a year, and gives you a clinician-reviewed answer with your stage and your next step.
Is this a diagnosis?
LiverStage gives a stage estimate from blood tests that plans accept, reviewed by a clinician. When your result calls for it, we connect you with a liver specialist who can confirm it.
Who reviews my result?
A licensed clinician reviews every result, under protocols written by liver specialists (hepatologists).
Who is LiverStage for?
Adults on a GLP-1 or deciding about one, adults told they have fatty liver or high liver enzymes, people with type 2 diabetes, and people who drink and want a personal answer.
I have hepatitis or another liver condition. Is LiverStage for me?
LiverStage is built for fatty liver and alcohol-related liver disease. If you have hepatitis B or C or another known liver condition, your own liver specialist is the right place for care.
Where is LiverStage available?
LiverStage starts in about 20 states. New York, New Jersey, Rhode Island and Maryland have extra rules for direct lab testing and come later. The risk check asks for your state and tells you whether we are there yet.
Testing
Do I need a doctor's order?
No visit with your own doctor is needed. An independent physician reviews your request and orders your tests.
Where is my blood drawn?
At a patient service center near you. You book the visit online.
Why does every member get ELF?
Many services run ELF only when FIB-4 is 1.3 or higher. FIB-4 can read low in people who already have scarring, so every member gets ELF at enrollment and every year after.
Why two draws a year?
The month-6 draw shows what is changing and keeps your results recent, which some plans ask for. The annual draw repeats the full panel and renews your documentation.
Do I need a FibroScan or another liver scan?
Only when your plan requires one for coverage, or when your blood results are unclear. We arrange it at a partner imaging site, billed to your insurance.
Can I connect my health records?
Yes, if you choose. You sign in to your patient portals and approve sharing, which takes a few minutes. We bring in past lab results, weight and medicines, calculate your past FIB-4 and SAFE, and show your trend before your first draw.
Why connect my records?
A single result shows where your liver is today. Years of past labs show which way it is heading, so a rising score gets attention sooner, and changes after a new medicine or routine are easier to see.
Results and care
How do I get my results?
In your LiverStage account, after a clinician has reviewed them. Each report leads with your stage and next step, with the numbers underneath.
What if my result says possible cirrhosis?
We help you book a prompt visit with a liver specialist for a fuller workup, and your care team follows up with you.
Can I talk to a specialist?
When your result calls for one, a hepatology or obesity-medicine specialist sees you by televisit, billed to your insurance or $149.
Will LiverStage prescribe treatment?
LiverStage does not sell medicines. A liver specialist can prescribe through a televisit, or your own clinician can use our documentation. We stay neutral on which treatment.
Cost and coverage
How much does it cost?
The risk check is free. Base is $249 a year and Plus is $299 a year. The alcohol module adds $99.
Does insurance pay for the membership?
The membership is paid directly. Specialist visits and any liver scan are billed to your insurance.
Will my plan cover treatment?
It may. Some plans cover medicine for liver scarring when the stage is documented with an accepted test and a specialist writes the prescription. We prepare that documentation. Coverage depends on your plan.
Can I get a refund on a pre-order?
Yes. Pre-orders are fully refundable.
Do I have to take the risk check before I order?
No. You can order directly. The risk check is there if you want to see your risk factors first.
Genetics, research and privacy
What does Plus add?
A multi-gene liver risk panel, run once from your first draw in a CLIA-certified lab, with your genetic risk included in every report and guidance for your family.
Are genetic results a diagnosis?
No. Genetic results describe risk, never a diagnosis. Your stage still comes from your blood tests.
What is the research tube?
One extra tube of blood at the same visit, stored for liver research under a separate consent, with a study code in place of your name.
What happens if I say no to research?
Nothing changes about your membership, your results or your care.
Who sees my data?
The clinicians caring for you. Anything beyond your care, like research, needs your separate consent.
Fatty liver means extra fat stored in liver cells. It is common: on liver scans, more than 1 in 4 US adults has it, and most do not know.
For most people, fatty liver stays mild. In some, the fat leads to inflammation, and over years the liver lays down scar tissue as it repairs itself. That scarring is called fibrosis.
How scarring is graded
F0: no scarring.
F1: mild scarring.
F2: moderate scarring.
F3: advanced scarring.
F4: cirrhosis, where scarring changes the structure of the liver.
Scarring is what predicts liver problems later in life, which is why LiverStage reports your stage and not only whether fat is present. Compared with no scarring, the risk of dying from liver disease is about 10 times higher at F2, 17 times at F3 and 42 times at F4. Heart disease, however, is the most common cause of death in people with fatty liver, so heart health matters at every stage.
Why people miss it
Scarring rarely causes symptoms until it is advanced. Liver enzymes can be normal. An ultrasound can show fat, but it cannot reliably show how much scarring there is.
It can improve
When its cause is treated, scarring often stops progressing and can improve. Losing about 5% of body weight lowers liver fat, 7 to 10% improves inflammation, and 10% or more can improve scarring. In one study of people who lost 10% or more over a year, inflammation cleared in 90% and scarring improved in 45%. Managing diabetes and drinking less help too, and medicines are approved for moderate to advanced scarring.
FIB-4 is a score calculated from four things already in routine blood work: your age, two liver enzymes (AST and ALT) and your platelet count.
Reading the number
Below 1.3: advanced scarring is unlikely.
1.3 to 2.67: the result is unclear, and a second test helps.
Above 2.67: advanced scarring is more likely, and a specialist should look.
From age 65, the low cut-off moves to 2.0, because FIB-4 rises with age. Under 35, the score is less reliable.
What FIB-4 can miss
FIB-4 was designed to rule out advanced scarring. It can read low in people who already have moderate scarring. That is why LiverStage adds SAFE and NFS, and runs ELF for every member.
GLP-1 medicines lower blood sugar and body weight, and weight loss reduces fat in the liver.
One GLP-1 medicine is now approved for liver scarring at the F2 to F3 stage. For some people that changes coverage: a plan that excludes GLP-1s for weight loss may cover one for liver scarring, when the stage is documented with an accepted test and a specialist writes the prescription.
When your stage matters
Before you start: your stage can affect which plan benefits apply.
During treatment: repeat checks show whether your liver is responding.
At renewal: some plans ask for evidence of a response.
LiverStage works alongside whoever prescribes your GLP-1 and stays neutral on which treatment.
Educational content, not medical advice for your situation.