Jeffrey V Lazarus1, Henry E Mark2, Marcela Villota-Rivas3, Adam Palayew4, Patrizia Carrieri5, Massimo Colombo6, Mattias Ekstedt7, Gamal Esmat8, Jacob George9, Giulio Marchesini10, Katja Novak11, Ponsiano Ocama12, Vlad Ratziu13, Homie Razavi14, Manuel Romero-Gómez15, Marcelo Silva16, C Wendy Spearman17, Frank Tacke18, Emmanuel A Tsochatzis19, Yusuf Yilmaz20, Zobair M Younossi21, Vincent W-S Wong22, Shira Zelber-Sagi23, Helena Cortez-Pinto24, Quentin M Anstee25. 1. Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; EASL International Liver Foundation, Geneva, Switzerland; Faculty of Medicine, University of Barcelona, Barcelona, Spain. Electronic address: jeffrey.lazarus@isglobal.org. 2. EASL International Liver Foundation, Geneva, Switzerland. 3. Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; EASL International Liver Foundation, Geneva, Switzerland. 4. EASL International Liver Foundation, Geneva, Switzerland; Department of Epidemiology, University of Washington, Seattle, USA. 5. Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France. 6. EASL International Liver Foundation, Geneva, Switzerland; Liver Center, IRCCS San Raffaele Hospital, Milan, Italy. 7. Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden. 8. Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. 9. Storr Liver Centre, Westmead Institute of Medical Research, Westmead Hospital and University of Sydney, Sydney, Australia. 10. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy. 11. University Medical Center Ljubljana, Department of Gastroenterology, Ljubljana, Slovenia. 12. Makerere University College of Health Sciences, Kampala, Uganda. 13. Pitie-Salpetriere Hospital, Department of Hepatology University Paris, Paris, France. 14. Center for Disease Analysis Foundation, Colorado, USA. 15. Digestive Diseases and ciberehd. Virgen del Rocío University Hospital. Institute of Biomedicine of Seville, University of Seville, Seville, Spain. 16. Hepatology and Liver Transplant Units, Hospital Universitario Austral, Buenos Aires, Argentina. 17. Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa. 18. Charité Universitätsmedizin Berlin, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Charité Mitte, 13353 Berlin, Germany. 19. UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK. 20. Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey; Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey. 21. Center for Liver Diseases, Inova Medicine, Falls Church, Virginia, USA. 22. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong. 23. University of Haifa, Faculty of Social Welfare and Health Sciences, School of Public Health, Mount Carmel, Haifa, Israel; Department of Gastroenterology, Tel-Aviv Medical Centre, Tel-Aviv, Israel. 24. Clinica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal. 25. Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
Abstract
BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent, yet largely underappreciated liver condition which is closely associated with obesity and metabolic disease. Despite affecting an estimated 1 in 4 adults globally, NAFLD is largely absent on national and global health agendas. METHODS: We collected data from 102 countries, accounting for 86% of the world population, on NAFLD policies, guidelines, civil society engagement, clinical management, and epidemiologic data. A preparedness index was developed by coding questions into 6 domains (policies, guidelines, civil awareness, epidemiology and data, NAFLD detection, and NAFLD care management) and categorising the responses as high, medium, and low; a multiple correspondence analysis was then applied. RESULTS: The highest scoring countries were India (42.7) and the United Kingdom (40.0), with 32 countries (31%) scoring zero out of 100. For 5 of the domains a minority of countries were categorised as high-level while the majority were categorised as low-level. No country had a national or sub-national strategy for NAFLD and <2% of the different strategies for related conditions included any mention of NAFLD. National NAFLD clinical guidelines were present in only 32 countries. CONCLUSIONS: Although NAFLD is a pressing public health problem, no country was found to be well prepared to address it. There is a pressing need for strategies to address NAFLD at national and global levels. LAY SUMMARY: Around a third of the countries scored a zero on the NAFLD policy preparedness index, with no country scoring over 50/100. Although NAFLD is a pressing public health problem, a comprehensive public health response is lacking in all 102 countries. Policies and strategies to address NAFLD at the national and global levels are urgently needed.
BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent, yet largely underappreciated liver condition which is closely associated with obesity and metabolic disease. Despite affecting an estimated 1 in 4 adults globally, NAFLD is largely absent on national and global health agendas. METHODS: We collected data from 102 countries, accounting for 86% of the world population, on NAFLD policies, guidelines, civil society engagement, clinical management, and epidemiologic data. A preparedness index was developed by coding questions into 6 domains (policies, guidelines, civil awareness, epidemiology and data, NAFLD detection, and NAFLD care management) and categorising the responses as high, medium, and low; a multiple correspondence analysis was then applied. RESULTS: The highest scoring countries were India (42.7) and the United Kingdom (40.0), with 32 countries (31%) scoring zero out of 100. For 5 of the domains a minority of countries were categorised as high-level while the majority were categorised as low-level. No country had a national or sub-national strategy for NAFLD and <2% of the different strategies for related conditions included any mention of NAFLD. National NAFLD clinical guidelines were present in only 32 countries. CONCLUSIONS: Although NAFLD is a pressing public health problem, no country was found to be well prepared to address it. There is a pressing need for strategies to address NAFLD at national and global levels. LAY SUMMARY: Around a third of the countries scored a zero on the NAFLD policy preparedness index, with no country scoring over 50/100. Although NAFLD is a pressing public health problem, a comprehensive public health response is lacking in all 102 countries. Policies and strategies to address NAFLD at the national and global levels are urgently needed.
Authors: Alberto Ferrarese; Sara Battistella; Giacomo Germani; Francesco Paolo Russo; Marco Senzolo; Martina Gambato; Alessandro Vitale; Umberto Cillo; Patrizia Burra Journal: Medicina (Kaunas) Date: 2022-02-14 Impact factor: 2.430