Europe is facing a growing chronic liver disease threat, according to a new Series published today in The Lancet Regional Health – Europe, that engaged more than 75 co-authors from 30 countries and was led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by the "la Caixa" Foundation. The Series, Ending the chronic liver disease public health threat in Europe , warns that Europe must move liver disease beyond hepatology and better integrate it into European health systems.
A silent burden affecting millions
Chronic liver disease is responsible for a substantial burden of premature illness and death across Europe, with disproportionate effects among men and socially disadvantaged populations. It is now second only to ischemic heart disease as the leading cause of years of working life lost in Europe.
The Series also warns that metabolic liver disease is rapidly reshaping Europe's liver health burden. It found that one in three people in the EU and UK are estimated to be living with metabolic dysfunction-associated steatotic liver disease (MASLD), now a leading driver of liver cancer in Europe.
Europe has the highest rates of alcohol consumption per person, the highest prevalence of heavy episodic drinking, and the lowest rates of abstention from alcohol in the world. Alcohol combines with obesity and other risk factors for liver disease to drive high rates of end-stage liver disease and liver cancer. Alcohol causes an estimated 40% of the 287,000 premature liver-related deaths in Europe every year, although the true number may be higher.
Across Europe, liver disease is already cutting into working-age health , with deaths from alcohol-related liver disease and undetected or untreated viral hepatitis often occurring decades earlier than many other chronic conditions. Hepatitis B and C account for more than 85 per cent of the nearly 57,000 annual deaths due to HIV, tuberculosis and viral hepatitis infections in the EU/EEA .
Beyond hepatology: a broader public health response
"Europe does not need another warning that liver disease is getting worse. It needs a different way of responding," said Jeffrey V. Lazarus , Professor at the CUNY Graduate School of Public Health and Health Policy and Head of the Public Health Liver Group at ISGlobal , and Chair of the Lancet Europe Series.
"When we talk about ultraprocessed food, alcoholic drinks and generally unhealthy diets, we are essentially talking about liver disease risk. When we talk about diabetes, obesity and sedentary lifestyles, we are also talking about that same risk. We need stronger public health policies and interventions to address this disease burden," Lazarus states. "And primary care also needs to change. It makes no sense that people are assessed for blood pressure, cholesterol and weight but not liver fibrosis," he adds.
The Series examines chronic liver disease from four complementary angles: 1) detection and care models, 2) MASLD policy preparedness, 3) alcohol-related liver disease and MetALD, and 4) progress towards viral hepatitis elimination.
It examines metabolic, alcohol-related and viral causes of liver disease together. "By examining these causes together, these papers show why Europe needs coordinated prevention, earlier detection, care pathways and a non-judgemental approach that connect liver health with diabetes, obesity, cardiovascular disease, alcohol policy, cancer prevention and the needs of underserved communities," said Elisa Pose, co-Chair of the Series.
In a Series comment, patient advocates Jeff McIntyre, Gina Bartes and Raquel Peck warned that individuals with liver disease frequently encounter assumptions and judgment that frame disease as solely a consequence of personal choices. "The stigma from this lack of context directly influences care-seeking, engagement, and health outcomes, while also shaping policy priorities and contributing to the persistent under-recognition of liver disease," they said.
Paul Brennan, co-Chair of the Series, added, "For too long we have accepted the normalisation of how society in general and industry lobbyists have directed blame upon individuals, rather than collective government and institutional responsibility and failings. Liver disease, especially MASLD, viral hepatitis and alcohol-related liver disease, disproportionately affect those most vulnerable in society. In this series we highlight how we can incorporate evidence-based interventions around diagnostics, preparedness, pathways of care and policy development to better protect the next generations of Europeans".
Missed opportunities for prevention and early detection
The authors also warn that millions of people with chronic liver disease remain undiagnosed. Earlier identification through primary and community-based care, including testing strategies and automated non-invasive liver fibrosis assessment, could prevent progression to fibrosis, cirrhosis, liver cancer and premature death.
Key recommendations include:
- Integrating liver health into non-communicable disease and cancer prevention strategies;
- Aligning liver disease responses with diabetes, obesity, alcohol, cardiovascular disease, physical activity and nutrition policies;
- Strengthening surveillance systems and early detection;
- Improving access to treatment and harm reduction services;
- Implementing stronger alcohol policies and reducing commercial drivers of harm;
- Addressing stigma and barriers affecting underserved communities.
"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," concludes Lazarus.
The Series was released to coincide with the Flagship Event hosted today in Barcelona by the Global Think-tank on Steatotic Liver Disease , an initiative of ISGlobal's Public Health Liver Group, ahead of this year's European Association for the Study of the Liver (EASL) Congress.
About the series
The Series comprises four papers and four accompanying comments. The papers focus on:
- Diagnostic innovation and models of care for chronic liver disease;
- MASLD policy preparedness in Europe;
- Alcohol-related liver disease and MetALD;
- Viral hepatitis control and elimination.
The accompanying comments address high-priority perspectives including patient advocacy, cultural and language barriers to care, laboratory medicine and the needs of people with autoimmune and rare liver diseases.
