"For every kilometer you move away from the beach in Barcelona, you gain quality of life."

BarcelonaIt is a disease that advances silently and already affects one in three adults, many of whom will eventually need a transplant. There are an increasing number of people worldwide with hepatic steatosis, popularly known as fatty liver disease. This condition, in Western and Middle Eastern countries, is closely linked to sedentary lifestyles and the consumption of alcohol and ultra-processed foods. Its consequences can be very serious: it can cause liver dysfunction and lead to liver fibrosis, which promotes the development of cardiovascular diseases such as heart attacks and strokes, as well as cancer and cirrhosis.

Despite its rising prevalence and the significant impact it has on the health of those who suffer from it, a team of researchers from the Barcelona Institute for Global Health (ISGlobal) warns in an article that this disease "is not a priority" in public health and calls for action to reduce its incidence. This has been echoed in the European edition of the journal The Lancet Regional Health, which published this Thursday the results of a study in which they analyzed the risk of developing it depending on the Barcelona neighborhood in which one lives.

Specifically, people who live in areas of the city with a high density of alcohol outlets and few healthy food offerings—that is, where access to fruits, vegetables, and fresh foods is more limited—are at greater risk of developing this disease. The head of the liver public health group at ISGlobal and lead author of the publication, Jeffrey Lazarus, explains that in Raval, Gòtic, and Barceloneta, the risk of suffering from fatty liver disease is higher than in other parts of the city where residents have more shopping options. These three neighborhoods also have more shops and establishments that sell alcohol.

According to the expert, in Ciutat Vella, for example, there are not as many decent supermarkets and they sell alcohol at all hours, although there are regulations to prevent this. "For every kilometer they move away from the beach in Barcelona, ​​​​the quality of life of residents increases," laments Lazarus, who insists that social determinants must be taken into account when talking about health. "You can't blame the people who live and suffer from the disease, because resources are more limited," argues the researcher.

Asymptomatic and untreated

Fatty liver disease is difficult to detect because it is asymptomatic until it reaches advanced stages, when it is already associated with more serious diseases. It would be helpful to promote aid for purchasing fruits and vegetables, impose taxes on unhealthy products such as sugary and alcoholic beverages, and improve the urban environment to promote a healthier lifestyle by implementing more bike lanes and green areas. This would also reduce the healthcare expenditure currently allocated to treating this liver disease and other related pathologies.

Until recently, people suffering from fatty liver disease had no therapeutic options. A year ago, the US drug regulator, the FDA, approved the world's first drug to combat fatty liver disease, and the European Medicines Agency (EMA) is expected to approve it this year. Namedwe will send, its development has involved researchers from Vall d'Hebron Hospital and manages to reduce the presence of fat, inflammation, cell damage, and fibrosis in the liver of people who suffer from it, when combined with diet and exercise. When this excess fibrous tissue occurs, the disease can progress to cirrhosis and, ultimately, organ failure. The liver is vital, so its approval in Europe would mark a turning point in the incidence of this growing disease.

An unrecognized challenge

However, fatty liver disease is currently excluded from strategies to address non-communicable (non-infectious) diseases in urban areas, including cancer, diabetes, chronic lung disease, and cardiovascular disease. The United Nations Sustainable Development Goals (SDGs) aim to reduce premature mortality from non-communicable diseases by one-third by 2030, so ISGlobal researchers reiterate the need to include fatty liver disease and strengthen a strategy to prevent it.

Although the analysis was conducted in Barcelona, ​​​​the authors believe the conclusions could be extrapolated to other urban areas. ISGlobal warns that the need to address this public health challenge "is immediate and requires collective action." Therefore, they call for the various administrations, both the City Council and the Catalan and Spanish governments, to work in a coordinated manner aligned with international recommendations to reduce the incidence of the disease.