Assessing Europe's policy readiness to confront the MASLD/MASH public health threat

Jeffrey V. Lazarus; Trenton M.  White; Leire Agirre-Garrido; Kushala W. M. Abeysekera; Paul N. Brennan; Radan Brůha; Stefan Buttigieg; Patrizia Carrieri; Helena Cortez-Pinto; Robert Flisiak; Sven M. A. Francque; Gema Frühbeck; Liliana Simona Gheorghe; Hannes Hagström; Adriaan G. Holleboom; Krasen Ivanov; Mojca Jensterle; Peter Jepsen; Juozas Kupcinskas; Henry E Mark; Didac  Mauricio; Saba Mohamed Bibi; Christophe Moreno; Anna Mrzljak; Eleni Papanicolaou; Maria Papp; Georgios Papatheodoridis; Markus Peck-Radosavljevic; Nicola Pugliese; Ryan D. Johnson; Rogério T.  Ribeiro; Riina Salupere; Lubomir Skladany; Ieva Tolmane; Hannele Yki-Järvinen; Jörn M Schattenberg; Juan M Pericàs

doi:10.1016/j.lanepe.2026.101713

Assessing Europe's policy readiness to confront the MASLD/MASH public health threat

Jeffrey V. Lazarus (Lead / Corresponding author)
, Trenton M. White (Lead / Corresponding author)
, Leire Agirre-Garrido
, Kushala W. M. Abeysekera
, Paul N. Brennan
, Radan Brůha
, Stefan Buttigieg
, Patrizia Carrieri
, Helena Cortez-Pinto
, Robert Flisiak
, Sven M. A. Francque
, Gema Frühbeck
, Liliana Simona Gheorghe
, Hannes Hagström
, Adriaan G. Holleboom
, Krasen Ivanov
, Mojca Jensterle
, Peter Jepsen
, Juozas Kupcinskas
, Henry E Mark

Didac Mauricio, Saba Mohamed Bibi, Christophe Moreno, Anna Mrzljak, Eleni Papanicolaou, Maria Papp, Georgios Papatheodoridis, Markus Peck-Radosavljevic, Nicola Pugliese, Ryan D. Johnson, Rogério T. Ribeiro, Riina Salupere, Lubomir Skladany, Ieva Tolmane, Hannele Yki-Järvinen, Jörn M Schattenberg, Juan M Pericàs,

Respiratory Medicine and Gastroenterology

Research output: Contribution to journal › Article › peer-review

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Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a public health threat in Europe. With an estimated 30.4% prevalence among the adult population in the European Union and United Kingdom, it is the most common chronic liver disease and is closely linked to obesity and type 2 diabetes, which can be considered as indicator conditions. Despite the scale of the burden, the spectrum of MASLD, including its advanced form, metabolic dysfunction-associated steatohepatitis (MASH), is weakly represented—or even absent—from health policy and development agendas. Further, the extent to which regional and national clinical practice guidelines (CPGs) on other liver diseases and related fields incorporate information on MASLD/MASH prevention or management is unclear. In this Series paper, we reviewed policy attention to MASLD/MASH across the European Union and the United Kingdom. We report low policy readiness across European countries to address MASLD/MASH. Only two (7.1%), Romania and Sweden, had a subnational strategy, while 13 (46.4%) referenced MASLD/MASH in other national or subnational action plans, predominantly those for liver disease and obesity. No country included MASLD/MASH in its priority non-communicable disease list. Additionally, 15 (53.6%) countries had national MASLD/MASH CPGs, while 25 (89.3%) mentioned MASLD/MASH in other national CPGs, most often those for obesity, diabetes, cirrhosis, liver transplantation, and primary care, respectively. We conclude that MASLD/MASH remains insufficiently addressed from a policy perspective, which contributes to low readiness to address this public health threat.

Original language	English
Article number	101713
Number of pages	17
Journal	The Lancet Regional Health - Europe
Volume	65
DOIs	https://doi.org/10.1016/j.lanepe.2026.101713
Publication status	Published - 2 Jun 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Food policy
Health policy
Health systems
Liver health
Non-communicable diseases
Obesity
Steatotic liver disease
Type 2 diabetes

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10.1016/j.lanepe.2026.101713Licence: CC BY-NC-ND

Final Published VersionFinal published version, 6.43 MBLicence: CC BY-NC-ND

Diagnostic innovation and models of care to improve fibrosis detection and risk stratification in steatotic liver disease
Pugliese, N., White, T. M., Brennan, P. N., Pannain, S., Hagström, H., Michel, M., Rice-Duek, L., Targher, G., Caussy, C., Dillon, J. F., Tacke, F., Kopka, C. J., Sebastiani, G., Boursier, J., Tsochatzis, E. A., Brouwer, W. P., Guaraldi, G., Vettor, R., Thiele, M. & Roden, M. & 8 others, Stefan, N., Jarvis, H., Ginès, P., Schattenberg, J. M., Pose, E., Buttigieg, S., Byrne, C. D. & Lazarus, J. V. (Lead / Corresponding author), 2 Jun 2026, In: The Lancet Regional Health - Europe. 65, 13 p., 101722.
Research output: Contribution to journal › Article › peer-review

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Implementation of evidence-based alcohol policies to reduce alcohol-related harm and liver disease to advance public health in Europe
Pose, E. (Lead / Corresponding author), Díaz, L. A., Parker, R., Israelsen, M., Marjot, T., Forrest, E., Dhanda, A., Paradis, C., Arab, J. P., Krag, A., Bataller, R., Murray, F., Lazarus, J. V., Carrieri, P. & Brennan, P. N., 2 Jun 2026, In: The Lancet Regional Health - Europe. 65, 101707.
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Open Access
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Cite this

Lazarus, J. V., White, T. M., Agirre-Garrido, L., Abeysekera, K. W. M., Brennan, P. N., Brůha, R., Buttigieg, S., Carrieri, P., Cortez-Pinto, H., Flisiak, R., Francque, S. M. A., Frühbeck, G., Gheorghe, L. S., Hagström, H., Holleboom, A. G., Ivanov, K., Jensterle, M., Jepsen, P., Kupcinskas, J. (2026). Assessing Europe's policy readiness to confront the MASLD/MASH public health threat. The Lancet Regional Health - Europe, 65, Article 101713. https://doi.org/10.1016/j.lanepe.2026.101713

@article{78c6fa53a39a4a22bf830075bddaaf7e,

title = "Assessing Europe's policy readiness to confront the MASLD/MASH public health threat",

abstract = "Metabolic dysfunction-associated steatotic liver disease (MASLD) is a public health threat in Europe. With an estimated 30.4\% prevalence among the adult population in the European Union and United Kingdom, it is the most common chronic liver disease and is closely linked to obesity and type 2 diabetes, which can be considered as indicator conditions. Despite the scale of the burden, the spectrum of MASLD, including its advanced form, metabolic dysfunction-associated steatohepatitis (MASH), is weakly represented—or even absent—from health policy and development agendas. Further, the extent to which regional and national clinical practice guidelines (CPGs) on other liver diseases and related fields incorporate information on MASLD/MASH prevention or management is unclear. In this Series paper, we reviewed policy attention to MASLD/MASH across the European Union and the United Kingdom. We report low policy readiness across European countries to address MASLD/MASH. Only two (7.1\%), Romania and Sweden, had a subnational strategy, while 13 (46.4\%) referenced MASLD/MASH in other national or subnational action plans, predominantly those for liver disease and obesity. No country included MASLD/MASH in its priority non-communicable disease list. Additionally, 15 (53.6\%) countries had national MASLD/MASH CPGs, while 25 (89.3\%) mentioned MASLD/MASH in other national CPGs, most often those for obesity, diabetes, cirrhosis, liver transplantation, and primary care, respectively. We conclude that MASLD/MASH remains insufficiently addressed from a policy perspective, which contributes to low readiness to address this public health threat.",

keywords = "Food policy, Health policy, Health systems, Liver health, Non-communicable diseases, Obesity, Steatotic liver disease, Type 2 diabetes",

author = "Lazarus, \{Jeffrey V.\} and White, \{Trenton M.\} and Leire Agirre-Garrido and Abeysekera, \{Kushala W. M.\} and Brennan, \{Paul N.\} and Radan Brůha and Stefan Buttigieg and Patrizia Carrieri and Helena Cortez-Pinto and Robert Flisiak and Francque, \{Sven M. A.\} and Gema Fr{\"u}hbeck and Gheorghe, \{Liliana Simona\} and Hannes Hagstr{\"o}m and Holleboom, \{Adriaan G.\} and Krasen Ivanov and Mojca Jensterle and Peter Jepsen and Juozas Kupcinskas and Mark, \{Henry E\} and Didac Mauricio and Bibi, \{Saba Mohamed\} and Christophe Moreno and Anna Mrzljak and Eleni Papanicolaou and Maria Papp and Georgios Papatheodoridis and Markus Peck-Radosavljevic and Nicola Pugliese and Johnson, \{Ryan D.\} and Ribeiro, \{Rog{\'e}rio T.\} and Riina Salupere and Lubomir Skladany and Ieva Tolmane and Hannele Yki-J{\"a}rvinen and Schattenberg, \{J{\"o}rn M\} and Peric{\`a}s, \{Juan M\}",

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year = "2026",

month = jun,

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doi = "10.1016/j.lanepe.2026.101713",

language = "English",

volume = "65",

journal = "The Lancet Regional Health - Europe",

issn = "2666-7762",

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Lazarus, JV, White, TM, Agirre-Garrido, L, Abeysekera, KWM, Brennan, PN, Brůha, R, Buttigieg, S, Carrieri, P, Cortez-Pinto, H, Flisiak, R, Francque, SMA, Frühbeck, G, Gheorghe, LS, Hagström, H, Holleboom, AG, Ivanov, K, Jensterle, M, Jepsen, P, Kupcinskas, J, Mark, HE, Mauricio, D, Bibi, SM, Moreno, C, Mrzljak, A, Papanicolaou, E, Papp, M, Papatheodoridis, G, Peck-Radosavljevic, M, Pugliese, N, Johnson, RD, Ribeiro, RT, Salupere, R, Skladany, L, Tolmane, I, Yki-Järvinen, H, Schattenberg, JM, Pericàs, JM 2026, 'Assessing Europe's policy readiness to confront the MASLD/MASH public health threat', The Lancet Regional Health - Europe, vol. 65, 101713. https://doi.org/10.1016/j.lanepe.2026.101713

TY - JOUR

T1 - Assessing Europe's policy readiness to confront the MASLD/MASH public health threat

AU - Lazarus, Jeffrey V.

AU - White, Trenton M.

AU - Agirre-Garrido, Leire

AU - Abeysekera, Kushala W. M.

AU - Brennan, Paul N.

AU - Brůha, Radan

AU - Buttigieg, Stefan

AU - Carrieri, Patrizia

AU - Cortez-Pinto, Helena

AU - Flisiak, Robert

AU - Francque, Sven M. A.

AU - Frühbeck, Gema

AU - Gheorghe, Liliana Simona

AU - Hagström, Hannes

AU - Holleboom, Adriaan G.

AU - Ivanov, Krasen

AU - Jensterle, Mojca

AU - Jepsen, Peter

AU - Kupcinskas, Juozas

AU - Mark, Henry E

AU - Mauricio, Didac

AU - Bibi, Saba Mohamed

AU - Moreno, Christophe

AU - Mrzljak, Anna

AU - Papanicolaou, Eleni

AU - Papp, Maria

AU - Papatheodoridis, Georgios

AU - Peck-Radosavljevic, Markus

AU - Pugliese, Nicola

AU - Johnson, Ryan D.

AU - Ribeiro, Rogério T.

AU - Salupere, Riina

AU - Skladany, Lubomir

AU - Tolmane, Ieva

AU - Yki-Järvinen, Hannele

AU - Schattenberg, Jörn M

AU - Pericàs, Juan M

PY - 2026/6/2

Y1 - 2026/6/2

N2 - Metabolic dysfunction-associated steatotic liver disease (MASLD) is a public health threat in Europe. With an estimated 30.4% prevalence among the adult population in the European Union and United Kingdom, it is the most common chronic liver disease and is closely linked to obesity and type 2 diabetes, which can be considered as indicator conditions. Despite the scale of the burden, the spectrum of MASLD, including its advanced form, metabolic dysfunction-associated steatohepatitis (MASH), is weakly represented—or even absent—from health policy and development agendas. Further, the extent to which regional and national clinical practice guidelines (CPGs) on other liver diseases and related fields incorporate information on MASLD/MASH prevention or management is unclear. In this Series paper, we reviewed policy attention to MASLD/MASH across the European Union and the United Kingdom. We report low policy readiness across European countries to address MASLD/MASH. Only two (7.1%), Romania and Sweden, had a subnational strategy, while 13 (46.4%) referenced MASLD/MASH in other national or subnational action plans, predominantly those for liver disease and obesity. No country included MASLD/MASH in its priority non-communicable disease list. Additionally, 15 (53.6%) countries had national MASLD/MASH CPGs, while 25 (89.3%) mentioned MASLD/MASH in other national CPGs, most often those for obesity, diabetes, cirrhosis, liver transplantation, and primary care, respectively. We conclude that MASLD/MASH remains insufficiently addressed from a policy perspective, which contributes to low readiness to address this public health threat.

AB - Metabolic dysfunction-associated steatotic liver disease (MASLD) is a public health threat in Europe. With an estimated 30.4% prevalence among the adult population in the European Union and United Kingdom, it is the most common chronic liver disease and is closely linked to obesity and type 2 diabetes, which can be considered as indicator conditions. Despite the scale of the burden, the spectrum of MASLD, including its advanced form, metabolic dysfunction-associated steatohepatitis (MASH), is weakly represented—or even absent—from health policy and development agendas. Further, the extent to which regional and national clinical practice guidelines (CPGs) on other liver diseases and related fields incorporate information on MASLD/MASH prevention or management is unclear. In this Series paper, we reviewed policy attention to MASLD/MASH across the European Union and the United Kingdom. We report low policy readiness across European countries to address MASLD/MASH. Only two (7.1%), Romania and Sweden, had a subnational strategy, while 13 (46.4%) referenced MASLD/MASH in other national or subnational action plans, predominantly those for liver disease and obesity. No country included MASLD/MASH in its priority non-communicable disease list. Additionally, 15 (53.6%) countries had national MASLD/MASH CPGs, while 25 (89.3%) mentioned MASLD/MASH in other national CPGs, most often those for obesity, diabetes, cirrhosis, liver transplantation, and primary care, respectively. We conclude that MASLD/MASH remains insufficiently addressed from a policy perspective, which contributes to low readiness to address this public health threat.

KW - Food policy

KW - Health policy

KW - Health systems

KW - Liver health

KW - Non-communicable diseases

KW - Obesity

KW - Steatotic liver disease

KW - Type 2 diabetes

U2 - 10.1016/j.lanepe.2026.101713

DO - 10.1016/j.lanepe.2026.101713

M3 - Article

SN - 2666-7762

VL - 65

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 101713

ER -

Assessing Europe's policy readiness to confront the MASLD/MASH public health threat

Abstract

UN SDGs

Keywords

Access to Document

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Research output

Diagnostic innovation and models of care to improve fibrosis detection and risk stratification in steatotic liver disease

Implementation of evidence-based alcohol policies to reduce alcohol-related harm and liver disease to advance public health in Europe

Cite this