The growing prevalence of metabolic dysfunction-associated steatotic liver disease and non-alcoholic steatotic hepatitis (MASLD/NASH) poses a growing public health risk, especially in high-income countries with high rates of obesity. Among the regions facing this epidemic is Europe, where nearly a third of the population is estimated to experience metabolic fatty liver disease. In the May 2026 edition of The Lancet Regional Health – Europe, Jeffrey Lazarus and colleagues published an exploration and assessment of Europe’s current MASLD/NASH public health policies. Following a comprehensive review of regional, national, and subnational policies, the authors identify significant gaps in most European countries’ public health strategies, clinical practice guidelines, and disease classification systems, suggesting a need for comprehensive reform. GlobalData epidemiologists forecast that between 2026 and 2032, the diagnosed prevalent cases of NASH will increase from over 11.1 million to nearly 11.8 million in five European countries (5EU: France, Germany, Italy, Spain, and the UK). In the absence of a coordinated strategy to raise awareness of and treat fatty liver disease, many patients will remain undiagnosed and face the possibility of worsening disease outcomes.
Lazarus and colleagues conducted an assessment review of MASLD/NASH action plans in the EU’s 27 countries, as well as the UK, using a multi-criteria meta-analysis. Their search included policy interventions to address associated risk factors (for example, obesity, alcohol use, diabetes, and cardiovascular disease), clinical practice guidelines on the diagnosis and treatment of MASLD/NASH, and monitoring initiatives in each country. Results indicated that among the 28 countries considered, only two, Spain and the UK, currently have a proposed action plan. In both countries, however, these plans have been proposed by non-governmental organisations instead of state agencies. Furthermore, 15 European countries have established clinical practice guidelines for the prevention, diagnosis, and treatment of MASLD/NASH. In countries with existing clinical practice guidelines, recommendations tend to take conservative diagnostic approaches, often advocating for the use of easily accessible serum-based non-invasive tests only for probable cases, while largely omitting testing for individuals with common comorbidities such as obesity and type 2 diabetes.
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In response to the relatively sparse attention to MASLD/NASH in European action plans and clinical practice guidelines, Lazarus and colleagues make a series of recommendations. Underlying their plan is a legislative strategy via the European Parliament to pass regionally binding health policies. These include formulating a European action plan that provides coherent guidelines on fatty liver prevention and monitoring, integrating steatotic liver disease in universal health coverage, strengthening regulation on nutritional guidance, and enhancing population-level surveillance of MASLD/NASH through primary care-driven integrated data systems. While the hurdles to a more comprehensive regional strategy are myriad, these suggestions provide an actionable framework that could motivate legislative action. Even through modest reform, European authorities and clinicians can make a discernible impact on one of the region’s most neglected public health crises.
