{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T15:36:33Z","timestamp":1789745793884,"version":"4.0.1"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hepatology Research"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Chronic liver disease (CLD), including metabolic dysfunction\u2010associated steatotic liver disease (MASLD), has emerged as a major public health concern. As CLD often progresses silently to cirrhosis and hepatocellular carcinoma, early detection and timely intervention are crucial. A significant gap exists between clinical risk perception and low public awareness regarding elevated alanine aminotransferase (ALT) levels. To address this discrepancy, the Japan Society of Hepatology launched the \u201cNara Declaration,\u201d a nationwide initiative promoting a new clinical action: \u201cConsult a primary care physician if ALT level is\u00a0&gt;\u00a030 U\/L.\u201d The Nara Declaration proposes a clear clinical pathway. Individuals with ALT &gt;\u00a030 U\/L are directed to a primary care physician who assesses the underlying etiology, including viral hepatitis, MASLD, alcohol\u2010related liver disease, or autoimmune liver diseases. For patients with suspected MASLD, physicians utilize the FIB\u20104 index or platelet count to stratify the risk of advanced fibrosis. Patients identified as high risk are then referred to a gastroenterologist\/hepatologist for further evaluation and management. This structured approach is significant, as it establishes a systematic and collaborative framework between primary care physicians and gastroenterologists\/hepatologists. This system enables the early detection of CLD and facilitates timely intervention for individuals at risk of disease progression. Accordingly, this declaration has the potential not only to reduce CLD\u2010related mortality and medical costs but also to improve healthy lifespans and social productivity. This special article outlines the Nara Declaration, providing a comprehensive overview. Furthermore, we introduce recent clinical studies that examine the impact of the Nara Declaration.<\/jats:p>","DOI":"10.1111\/hepr.70065","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T09:04:31Z","timestamp":1763456671000},"page":"3-8","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Nara Declaration: A New Collaborative Flow for Chronic Liver Disease Between Primary Care Physicians and Gastroenterologists\/Hepatologists"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7064-4325","authenticated-orcid":false,"given":"Takumi","family":"Kawaguchi","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Department of Medicine Kurume University School of Medicine  Kurume 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