European countries show low policy readiness for MASLD/MASH, hindering timely detection and care
Background
Metabolic dysfunction-associated steatotic liver disease (MASLD) and its advanced form, metabolic dysfunction-associated steatohepatitis (MASH), represent the most prevalent chronic liver diseases in Europe, imposing a significant economic burden. These conditions are strongly linked to indicator conditions such as obesity and type 2 diabetes. Despite their widespread impact, current policy frameworks often fall short in providing comprehensive strategies for timely detection, effective management, and coordinated care, creating a critical public health gap.
Study Design
Researchers conducted a cross-sectional analysis of policy documents and clinical practice guidelines (CPGs) from 27 European Union countries and the United Kingdom (n=28). The study assessed the inclusion and integration of MASLD/MASH within national health strategies, non-communicable disease (NCD) frameworks, and speciality-specific CPGs, including those for endocrinology and cardiovascular disease. Additionally, a meta-analysis was performed to estimate the prevalence of MASLD among the adult population across these 28 countries.
Results
The analysis revealed consistently low policy readiness across the 28 European countries to address MASLD/MASH. Inclusion of MASLD/MASH in speciality-specific clinical practice guidelines (CPGs), such as those for endocrinology and cardiovascular disease, remained low. Compared with established policies for obesity and diabetes, MASLD/MASH continues to be significantly under-recognized, which limits opportunities for crucial resource allocation, timely detection, and coordinated care pathways. This under-recognition contributes to late diagnoses and fragmented patient management. Furthermore, the meta-analysis estimated a substantial MASLD prevalence of > 30.4% (95% CI: 21.7%–39.8%) among the adult population in the 28 countries included in the study, underscoring the urgency for policy intervention.
Key Findings
- MASLD prevalence in 28 European countries is estimated at 30.4% (95% CI: 21.7%–39.8%) among adults.
- 27 EU countries and the UK demonstrate low policy readiness to address MASLD/MASH.
- Inclusion of MASLD/MASH in speciality-specific
clinical practice guidelinesremains low across countries. - MASLD/MASH is under-recognized compared to obesity and diabetes policies, limiting resource allocation.
- Actionable policy gaps include weak national strategies, NCD frameworks, and lack of multidisciplinary care pathways.
Why It Matters
This research highlights a critical gap in public health policy across Europe, indicating that current frameworks are ill-equipped to manage the growing burden of MASLD/MASH. For clinicians and policymakers, the practical takeaway is the urgent need to strengthen national strategies, integrate MASLD/MASH into NCD frameworks, and update CPGs across relevant specialities. This includes investing in robust surveillance and risk stratification tools, alongside developing multidisciplinary care pathways to facilitate earlier detection and more effective management. Without these policy developments, countries face continued late diagnoses, fragmented care, and escalating healthcare costs, hindering the implementation of emerging evidence-based management innovations.
masld
mash
policy
public-health
europe
liver-disease