Study on health policy on fatty liver (MASLD/MASH) in Europe: how well prepared are the countries?

In short: Around 30% of adults in Europe have fatty liver (MASLD), yet policy has barely responded. A review of 28 countries (the EU and the UK) found not a single national strategy specifically on MASLD and MASH. Only 2 countries, Romania and Sweden, have a regional strategy, and no country lists the condition among its priority non-communicable diseases ¹.

Status of the evidence: The study’s search covers sources up to 15 November 2025. The paper was published online on 25 May 2026 in The Lancet Regional Health – Europe (volume 65, 2026). Article written on 4 October 2026. Newer policy decisions are not covered.

What is this about?

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in Europe. A pooled analysis of 18 studies puts its prevalence at 30.4% of adults. Its inflammatory form is called MASH. About 3% of affected people without cirrhosis develop cirrhosis within 15 to 20 years. In Europe, fatty liver is the second most common cause of end-stage liver disease and liver transplantation. The study does not look at medicine but at policy: how well prepared are countries? ¹

How was this assessed?

The research team searched databases, government sources and the literature for strategies, action plans and clinical guidelines. Local experts in the 28 countries checked the results.

What does the study show?

• No national strategy. No country has a government-issued MASLD/MASH strategy. In Spain and the UK there are plans from a medical association and a non-governmental organisation.
• Only passing mentions. In 13 countries (46.4%) the condition appears in other strategies, mostly on obesity (10 countries), liver disease (8) and diabetes (7). Often it is only a superficial mention.
• Guidelines are further ahead. 15 countries (53.6%) have a national MASLD/MASH guideline, and 25 (89.3%) mention it in other guidelines. Among obesity guidelines it was 86.4%, among diabetes guidelines 46.2%, and in primary care guidelines only 50%.
• Mismatch with how common it is. Diabetes, cardiovascular disease and cancer receive far more political attention and funding than fatty liver.

Why is this a problem?

Without a policy framework, fatty liver is often found late, care is split between liver, diabetes and family doctor practices, and people with lower incomes are reached less often. With new tests and the first approved drugs, the need for well-organised care is growing ¹.

What do the authors recommend?

MASLD/MASH should be included in national strategies on non-communicable diseases. This includes guidelines, data for detecting and monitoring the disease, and care pathways in which family doctors, endocrinology, cardiology and hepatology work together. They also name healthy diet, physical activity, less alcohol and rules on ultra-processed food as important building blocks ¹.

Where are the limits?

The study measures policy readiness, not how well care actually works. Despite targeted searches and checks by local experts, documents may have been missed. Policy on nutrition, agriculture or taxes often does not name the liver explicitly. Many authors report fees or funding from pharmaceutical companies ¹.

What does this mean for me?

The study gives no treatment recommendation. For those affected it means: fatty liver often goes unnoticed and is not automatically looked for. If you have diabetes, overweight or other metabolic risks, raise the topic of your liver with your family doctor. On the policy side, professional and patient organisations are calling for fatty liver to be included in WHO and EU plans between 2026 and 2030.

This article does not replace medical advice.