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

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.