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LiverWare

How LiverWare works

LiverWare connects a two-stage educational screening flow with practical health education and signed-in support tools.

The educational screening flow

  1. Stage 1 screening. A user provides self-reported health and basic measurement information.
  2. Educational classification. LiverWare organizes those inputs into a project-defined educational risk classification.
  3. Optional Stage 2 output. A user can provide age, AST, ALT, and platelet count to calculate FIB-4 as a separate output.

What Stage 1 asks about

Stage 1 has a maximum of 9 points. Sections A to D cover cardiometabolic risk factors (up to 6 points) and Section E covers lifestyle factors (up to 3 points). Answers such as "I don't know" or "Not sure" add no points. For blood sugar and blood pressure, the screening also shows a note suggesting the missing check.

Section A: Body composition (up to 2 points)
Body mass index (BMI) and waist circumference are counted separately. A BMI of 25.0 kg/m² or higher counts, following the WHO general BMI classification. Waist circumference uses sex-specific cutoffs for Asian adults.
Section B: Blood sugar (up to 1 point)
A diabetes diagnosis, diabetes medication, or a fasting blood glucose above 100 mg/dL (5.6 mmol/L). These describe the same risk factor, so the section counts once even when more than one applies.
Section C: Blood pressure (up to 1 point)
The 2023 multi-society consensus counts blood pressure of 130/85 mmHg or higher, or treatment for high blood pressure, as a cardiometabolic risk factor.
Section D: Blood fats (up to 2 points)
Triglycerides above 150 mg/dL (1.70 mmol/L) and low HDL cholesterol are counted separately. Cholesterol medication counts only when the matching lab value is not available, so it never overrides a normal result.
Section E: Lifestyle (up to 3 points)
Family history of liver disease, physical activity (exercise days and how active the rest of the day is), and diet (fried or processed food and sugary drinks).
Alcohol check: AUDIT-C (flag only, never scored)
Three standard AUDIT-C questions about drinking. A total of 4 or more for men, or 3 or more for women, shows an alcohol flag, because alcohol can also affect the liver. The flag appears beside the result and is never added to the 9-point total.

Result tiers and reassessment reminders

The Stage 1 total places the result in a low, moderate, or high educational tier. Each tier comes with tier-matched food guidance and a reminder to repeat the screening, following the follow-up intervals in the 2024 EASL-EASD-EASO guidelines:

  • Low: reassess in 12 months.
  • Moderate: reassess in 6 months.
  • High: reassess in 3 months.

Stage 2: the FIB-4 index

FIB-4 is a widely used first-step estimate of liver scarring (fibrosis) that needs only age and three routine blood test values. It is calculated as (age × AST) ÷ (platelet count × √ALT).

A value below 1.30 suggests a lower probability of advanced fibrosis, a value above 2.67 suggests a higher probability, and values in between are indeterminate. For adults 65 and older, the lower cutoff is 2.0. Below age 35, FIB-4 has limited accuracy and LiverWare says so instead of placing the value in a band.

FIB-4 is shown on its own and is never added to the Stage 1 total.

What the result means

The result supports education and follow-up conversations. It does not diagnose or rule out MASLD or fibrosis, and it is not a substitute for professional medical advice.

Tools available after sign-in

Signed-in users can access educational food guidance, medication organization, doctor-directory information, reports, and Livvy. These tools help users organize information and prepare questions for a licensed professional.

Livvy's role

Livvy provides cited health education and does not diagnose or prescribe. Its explanations can support learning, but they do not replace a professional review of personal symptoms, history, or laboratory results.

Common questions

What is MASLD?

MASLD stands for metabolic dysfunction-associated steatotic liver disease. It is the name a 2023 multi-society consensus gave to the condition previously called non-alcoholic fatty liver disease (NAFLD). It describes fat build-up in the liver together with at least one cardiometabolic risk factor, such as excess weight, high blood sugar, high blood pressure, or abnormal blood fats.

Is a LiverWare result a diagnosis?

No. MASLD is diagnosed by a licensed professional, usually with imaging or other tests. LiverWare's tiers show which known risk factors are present so you can bring specific questions to a consultation.

Do I need lab results to start?

No. Stage 1 accepts "I don't know" for lab values such as fasting glucose and triglycerides. Stage 2 is optional and needs AST, ALT, and platelet count from a recent blood test.

Why does LiverWare ask about alcohol if it is not scored?

Liver fat can also come from alcohol use. The AUDIT-C flag helps you and your doctor consider that possibility without changing the metabolic risk total.

What happens to my answers?

Answers are stored in LiverWare's database, not in your browser. Guest screening records that are not linked to an account are deleted after 24 hours. The Privacy Policy explains what is collected, how long it is kept, and how to request deletion.