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Chronic liver diseases are becoming one of the most significant yet least recognized health threats in Europe, and experts are urging healthcare systems across the continent to respond far more urgently.

A recent series of articles, Ending the chronic liver disease public health threat in Europe, published in The Lancet Regional Health - Europe, warns that Europe is facing an underrecognized liver crisis.

A Widespread, Silent Burden

The series, led by the Barcelona Institute for Global Health (ISGlobal) and authored by more than 75 experts from 30 countries, examines liver disease from multiple angles: screening, care models, metabolic dysfunction-associated steatotic liver disease (MASLD), MetALD (the combination of metabolic and alcohol-related liver disease), alcohol-related liver disease, and viral hepatitis. The authors urge liver health to be linked to policies on diet, obesity, alcohol, and other noncommunicable diseases.

MASLD is rapidly changing Europe’s liver health burden. Overall, chronic liver disease represents a major cause of premature mortality, with a disproportionate impact on men and socially disadvantaged populations.

It also hits the working-age population: It is the second leading cause of years of working life lost in Europe, after ischemic heart disease. Despite this, its prominence in health strategies remains lower than one might expect given its disease burden. Current estimates suggest about 1 in 3 people in the EU and the UK have MASLD. The condition is a leading driver of liver cancer in Europe, and when combined with alcohol-related liver disease or untreated viral hepatitis, it contributes to deaths that typically occur decades earlier than deaths from many other chronic diseases.

MASLD: An Increasingly Common Disease

Speaking to Univadis Spain, part of the Medscape Professional Network, Jeffrey V. Lazarus, head of the Public Health Liver Group at ISGlobal, professor at the CUNY Graduate School of Public Health and Health Policy, and chair of the Lancet Europe series, said MASLD affects 1 in 4 adults in Spain. The condition is associated with diabetes and other extrahepatic diseases, particularly cardiovascular conditions.

“With such a high proportion of the adult population having this disease, many are at risk of developing serious liver disease. That is why we are also seeing increasing cases of cirrhosis and liver cancer, both in Spain and around the world,” he said. He also explained that some patients develop an inflammatory and progressive form of the disease, known as metabolic dysfunction-associated steatohepatitis (MASH).

He added: “The development of fibrosis is the best predictor of severe liver disease.” The disease can progress from hepatic steatosis to MASH, fibrosis, and subsequently, cirrhosis or liver cancer. Obesity, type 2 diabetes, a sedentary lifestyle, and unhealthy eating habits are the main drivers of MASLD. Alcohol use can further exacerbate the progression of liver damage.

Alcohol as an Aggravating Factor

Europe has the highest per-person alcohol consumption, the highest prevalence of binge drinking, and the lowest rates of abstinence in the world. Alcohol is a major aggravating factor in liver damage and is associated with higher rates of end-stage liver disease and liver cancer.

Lazarus was unequivocal: “If you have this disease, you must stop drinking alcohol completely. Drinking alcohol is like pouring gasoline on a fire when liver problems already exist. If you already have a liver problem, such as fibrosis, drinking alcohol becomes a serious matter.”

He continued: “When a person drinks alcohol and has fatty liver disease, they develop what we call MetALD, which is a combination of metabolic and alcoholic disease. When alcohol consumption is high, alcohol-related liver disease develops, and in these cases, we see even worse health outcomes than in MASLD or MASH.”

It is estimated that alcohol is responsible for 40% of the 287,000 premature deaths related to liver disease that occur each year in Europe, although the actual figure could be even higher.

The Role of Viral Hepatitis

In the EU and the European Economic Area, hepatitis B and C account for more than 85% of the approximately 57,000 annual deaths linked collectively to HIV, tuberculosis, and viral hepatitis. Lazarus noted that a key part of the response involves detection and prevention.

“We have not eliminated viral hepatitis B and C, neither in Spain nor in the rest of Western Europe, despite having medications that can cure hepatitis C in 8-12 weeks. We’re not doing badly in Spain, but 10 years after those medications became available in the country, there are still thousands of people who remain undiagnosed and have not received treatment.”

The expert recounted outreach work with a program involving immigrant groups from countries with a high prevalence of hepatitis B, which found hepatitis B in about 10% of participants. He added: “Health services must reach the people who have these diseases, rather than having them come to the [medical] service and be fortunate enough to undergo diagnostic testing. Many people are not being diagnosed and may later develop more serious hepatic or extrahepatic diseases.”

Beyond Hepatology: Public Health and Policy Action

The series argues for a broader public-health response to the worsening burden of liver disease. This involves addressing unhealthy diets, ultraprocessed foods, or alcohol consumption and their connection to diabetes, obesity, and a sedentary lifestyle. Public health policies and interventions must focus on these areas to tackle this burden of liver disease.

“The response must include public education and regulation,” Lazarus said. “This isn’t just a problem for liver disease but also for diabetes and cardiovascular diseases.” He highlighted taxation on alcoholic beverages as an evidence-based policy that reduces consumption and suggested similar fiscal or regulatory approaches could be considered for ultraprocessed foods and junk food. Governments must also recognize the commercial drivers that make unhealthy products widely available.

Addressing Stigma and Inequality

Stigma is a major barrier linked to liver disease. Framing liver disease as an individual failing, linked to alcohol or obesity rather than to social, economic, and environmental factors, discourages people from seeking care and helps explain why liver disease remains politically and clinically underprioritized.

Paul Brennan, co-chair of the series, said that blame has been normalized for years while the structural causes — limited access to healthy food, constrained resources for healthy living, and social acceptance of heavy drinking — are overlooked. Conditions such as MASLD, viral hepatitis, and alcohol-related liver disease disproportionately affect the most vulnerable populations.

An Integrated and Earlier Response

The series calls for a more coordinated public health response, aligning policies on liver disease with strategies addressing obesity, diabetes, cardiovascular disease, and alcohol consumption.

Elisa Pose, co-chair of the series, stated: “By examining these causes together, these papers show why Europe needs coordinated prevention, earlier detection, care pathways and a nonjudgemental approach that connect liver health with diabetes, obesity, cardiovascular disease, alcohol policy, cancer prevention and the needs of underserved communities.”

The authors advocate incorporating evidence-based interventions focused on early diagnosis, strengthening healthcare systems, and developing public policies aimed at reducing the future burden of liver disease in Europe. They warn that millions of people with chronic liver disease remain undiagnosed. Earlier identification in primary care and the community setting, including screening strategies and noninvasive fibrosis testing, could prevent progression to cirrhosis, liver cancer, and premature death.

“Ending chronic liver disease as a public health threat in Europe is possible but only if Europe acts before advanced disease becomes the default point of diagnosis,” Lazarus concluded. He warned that MASLD is both highly prevalent and still undervalued in public and clinical attention.

Barcelona: A Hub for Liver Health

From May 26 to 30, major conferences on liver health took place in Barcelona. Lazarus said: “This disease has many repercussions on the body, which is why 6000 people from over 50 countries have gathered in Barcelona these past few days [up to 8000 according to organizers, at the EASL Congress 2026], and the Global Think-tank on Steatotic Liver Disease brought 150 people from 30 countries to discuss this topic. The conversation has revolved around liver health, so I am grateful for the attention being paid to this issue. There is a major problem with liver health, and yet it remains invisible to much of society.”

This story was translated from Univadis Spain, part of the Medscape Professional Network.