Steatotic Liver Disease, a Public Health Threat in Barcelona

Steatotic liver disease, formerly known as fatty liver disease, is a group of conditions in which fat accumulates abnormally in liver cells. This can lead to inflammation and fibrosis (scarring of the liver), potentially causing liver damage and, over time, cirrhosis and even liver cancer. A new study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation, highlights that steatotic liver disease is not included among the priorities of global or national public health policies, despite affecting more than a third of the world’s adult population. The article was published in The Lancet Regional Health – Europe.

Despite its high prevalence worldwide, steatotic liver disease is largely excluded from strategies to tackle non-communicable diseases (NCDs) in urban areas. NCDs include all non-infectious diseases such as cancer, diabetes, chronic respiratory diseases, and cardiovascular diseases. Among the Sustainable Development Goals (SDGs), SDG 3.4 aims to reduce premature mortality from non-communicable diseases by one third by 2030.

In Barcelona, a large number of adults have liver fibrosis, an advanced stage of liver damage. The degree of fibrosis is the main risk factor for mortality in people living with liver diseases associated with metabolic disorders, such as cardiovascular disease.

“To highlight the need to integrate steatotic liver disease into public health policies, we took the city of Barcelona as a case study, as we will discuss at a Global Think-tank event on Steatotic Liver Disease this June,” explains Jeffrey V. Lazarus, Head of the Liver Public Health Group at ISGlobal and lead author of the study. By analysing risk factors associated with NCDs—such as alcohol consumption, smoking and limited availability of healthy food—researchers identified the urban areas most at risk.

Ciutat Vella, the district dominated by unhealthy food outlets

Certain characteristics of the urban environment are associated with a higher risk of developing steatotic liver disease and with its progression to more advanced stages. A geospatial analysis identified some areas in Barcelona with a high density of alcohol outlets and limited access to healthy food (such as fruit, vegetables, or fresh produce), like neighborhoods in Ciutat Vella.

These areas, known as "NCD risk zones," could benefit from targeted interventions such as subsidies for fruit and vegetables, taxes on sugary and alcoholic drinks, and improvements to the urban environment that support a healthier lifestyles, such as the creation of cycle lanes.

Rapid and coordinated action

Although the analysis was conducted in Barcelona, the conclusions may be applicable to other urban areas. The study emphasizes the importance of urban health policies being based on accurate and objective information, gathered with the participation of citizens and free from commercial influence. Addressing this challenge is urgent and requires collective action.

“To reduce the health burden of liver disease and meet global health goals, it is crucial for local, regional, and national governments to work in a coordinated manner and align with international recommendations,” concludes Dana Ivancovsky Wajcman, researcher at ISGlobal and last author of the study.

Reference

Lazarus JV, Miralles-Sanchez JE, Agirre-Garrido L, Brachowicz N, Nicolàs A, Armenta A Jr, Boudou D, Rice-Duek L, Pericàs JM, Benach J, Kopka CJ, Wajcman DI. A call to action to address the steatotic liver disease public health threat in Barcelona. Lancet Reg Health Eur. 2025 Mar 22;52:101272. https://doi.org/10.1016/j.lanepe.2025.101272