This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The foundational paradigm of modern medicine is shifting from a reactive, treatment-focused model to a proactive strategy emphasizing early detection and prevention. This transition, necessitated by the escalating global prevalence of noncommunicable diseases, places primary care physicians at the center of healthcare delivery [1]. They are no longer merely managers of acute conditions but must now identify subtle preclinical indicators of chronic diseases. These conditions frequently remain latent or silent for extended periods (often years or decades) before manifesting as severe complications. The efficacy of this preventive model is well established; extensive screening for hypertension and hyperlipidemia, frequently guided by validated risk calculators, has substantially reduced cardiovascular morbidity and mortality [2]. Similarly, guideline-based cancer screening is the cornerstone of contemporary preventive health [3]. This challenge remains particularly acute in metabolic and age-related disorders. For example, metabolic dysfunction-associated steatotic liver disease (MASLD) is largely asymptomatic until its progression to advanced fibrosis or cirrhosis [4]. This underscores the urgent need for effective, feasible, and noninvasive screening strategies and risk stratification tools that can be seamlessly integrated into the daily primary care workflow.
This review introduces three important studies united by a common thematic framework: proactive screening and early risk stratification within primary care settings. These articles, each from a different clinical domain—MASLD, gestational diabetes, and age-related comorbidities—offer valuable insights into methodologies for predicting health risks and facilitating early intervention.
Nowak et al. [5] contributed a comprehensive review of the “implementation of noninvasive liver disease screening tools in primary care.” Given the increasing global prevalence of MASLD, a condition largely asymptomatic until advanced stages, the authors addressed the limitations of liver biopsy, which is the invasive and costly diagnostic gold standard. They explored how noninvasive tests (NITs), such as Fibrosis-4 (FIB-4) Index, the Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS), and elastography, function as invaluable alternatives in the primary care environment. This study extends beyond listing tools, emphasizing the clinical importance of a proactive screening strategy using “stepwise screening models” with NITs, which may reduce unnecessary specialist referrals and improve diagnostic efficiency.
Subsequently, Kim et al. [6] elucidated this proactive paradigm, extending it from screening existing diseases to predicting future complications. Gestational diabetes mellitus (GDM) necessitates meticulous management both for the glycemic disorder and the elevated risk of various maternal and neonatal complications. This study demonstrates that glycated albumin (GA) levels measured during the third trimester can serve as a valuable biomarker for predictive stratification. The researchers proposed an optimal GA cut-off value of 12.45%, providing clinicians with a practical tool for risk assessment. This finding may enable a priori identification of high-risk mother-neonate dyads, allowing for more intensive monitoring and tailored management.
Finally, Lee et al. [7] highlighted the necessity for proactive screening that extends beyond a single pathology to encompass associated and sometimes unexpected comorbidities. This study identified a significant association between low bone mineral density (BMD) and high-frequency hearing impairment in Korean women aged over 50 years. Specifically, reduced lumbar spine BMD was found to correlate with hearing thresholds at 4,000 and 8,000 Hz. This finding suggests the clinical relevance of a holistic approach: clinicians managing osteoporosis should consider proactive screening for auditory deficits; conversely, the presence of hearing impairment in this population may warrant BMD assessment.
The three studies featured in this issue originating from distinct clinical fields collectively underscore the profound value of proactive information for early intervention. This principle holds true whether applied to early detection of MASLD [5], prediction of GDM-related complications [6], or identification of hearing loss associated with osteoporosis [7]. Therefore, primary care physicians function not merely as responders to established illnesses but also as stewards of preventive health, actively utilizing these practical screening tools and predictive markers to safeguard long-term well-being. It is hoped that these results will serve as invaluable guidelines for integrating proactive screening strategies into routine clinical practice.
Article Information
Conflict of interest
Su Hwan Cho is an Associate Editor of the journal but was not in volved in the peer reviewer selection, evaluation, or decision process of this article. Except for that, no other potential conflicts of interest relevant to this article were reported.
Funding
None.
Data availability
Not applicable.
Author contribution
All the work was done by Su Hwan Cho.
References
1. Benziger CP, Roth GA, Moran AE. The global burden of disease study and the preventable burden of NCD. Glob Heart 2016;11:393-3.
2. Townsend N, Kazakiewicz D, Lucy Wright F, Timmis A, Huculeci R, Torbica A, et al. Epidemiology of cardiovascular disease in Europe. Nat Rev Cardiol 2022;19:133-43.
4. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018;67:328-57.
5. Nowak K, Nowak A, Jablonska A, Potaczek A, Salacha J, Dardzinska N, et al. Implementation of noninvasive liver disease screening tools in primary care. Korean J Fam Med 2025;46:381-90.
6. Kim J, Lee S, Kim JS. Usefulness of glycated albumin levels in predicting the maternal or neonatal complications of gestational diabetes mellitus during late pregnancy in South Korea: a retrospective study. Korean J Fam Med 2025;46:401-8.
7. Lee SH, Lee SS, Park HY, Kim BT. Low bone mineral density is associated with high-frequency hearing impairment in women over 50: an observational study in Korea. Korean J Fam Med 2025;46:418-25.
