The global NAFLD policy review and preparedness index: are countries ready to address this silent public health challenge?

• Author(s): Lazarus, Jeffrey V. ; Mark, Henry E. ; Villota-Rivas, Marcela ; Palayew, Adam ; Carrieri, Patrizia ; Colombo, Massimo ; Ekstedt, Mattias ; Esmat, Gamal ; George, Jacob ; Marchesini, Giulio ; Novak, Katja ; Ocama, Ponsiano ; Ratziu, Vlad ; Razavi, Homie ; Romero-Gómez, Manuel ; Silva, Marcelo ; Spearman, C. Wendy ; Tacke, Frank ; Tsochatzis, Emmanuel A. ; Yilmaz, Yusuf ; Younossi, Zobair M. ; Wong, Vincent W.-S. ; Zelber-Sagi, Shira ; Cortez-Pinto, Helena ; Anstee, Quentin M. ; Rouabhia, Samir ; Ghazinyan, Hasmik ; Iskandar, Natacha Jreige ; Trauner, Michael ; Aghayeva, Gulnara ; Carter, Flloyd ; Sridharan, Kannan ; Al Mahtab, Mamun ; Francque, Sven ; Kodjoh, Nicolas ; Camacho, Ruben Muñoz ; Anderson, Motswedi ; Marques Souza de Oliveira, Claudia Pinto ; Mateva, Lyudmila ; Serme, Abdel Karim ; Soares Martins, Antonieta A. ; Swain, Mark G. ; Komas, Narcisse Patrice ; Zheng, Ming-Hua ; Jaramillo, Patricio Lopez ; Murillo, Omar Alfaro ; Mikolasevic, Ivana ; Vounou, Emmelia ; Brůha, Radan ; Nlombi, Charles Mbendi ; Thiele, Maja ; Perez, Marlene ; Suárez M, Juan José ; Waked, Imam ; Salupere, Riina ; Desalegn, Hailemichael ; Yki-Järvinen, Hannele ; Tsertsvadze, Tengiz ; Sharvadze, Lali ; Butsashvili, Maia ; Awuku, Yaw Asante ; Papatheodoridis, Georgios ; Hunyady, Bela ; Bjornsson, Einar Stefan ; Duseja, Ajay ; Lesmana, Cosmas Rinaldi A. ; Malekzadeh, Reza ; Norris, Suzanne ; Koike, Kazuhiko ; Nersesov, Alexander V. ; Ochwoto, Missiani ; Jamal, Mohammad ; Saparbu, Tobokalova ; Tolmane, Ieva ; Sayegh, Raymond ; Sheriff, Dhastagir Sultan ; Valantinas, Jonas ; Weber, Joseph ; Shawa, Isaac Thom ; Tan, Soek-Siam ; Martínez Vázquez, Sophia E. ; Baatarkhuu, Oidov ; Lkhagvaa, Undram ; Jadamba, Tsolmon ; Mohammed, Tahiri ; Sudhamshu, K.C ; Coppell, Kirsten ; Onyekwere, Charles ; Nikolova, Dafina ; Vesterhus, Mette ; Al-Naamani, Khalid ; Hamid, Saeed ; Méndez, Juan Paredes ; Cabrera Cabrejos, María Cecilia ; Flisiak, Robert ; Torres, Esther A. ; Taheri, Shahrad ; Sung, Ki-Chul ; Adela, Turcanu ; Gheorghe, Liana ; Sanai, Faisal M. ; Milovanovic, Tamara ; Bee Goh, George Boon ; Rac, Marek ; Dassanayake, Anuradha ; Osama, Shahinaz Bedri ; Elsanousi, M. ; Dufour, Jean-François ; Kao, Jia-Horng ; Saidi, Dilshod ; Treeprasertsuk, Sombat ; Koek, Ger ; Labidi, Asma ; Skrypnyk, Igor ; AlKhatry, Maryam Salem ; Sadirova, Shakhlo ; Bakieva, Shokhista ; Sinkala, Edford
• Date: 2022
• Persistent ID: http://hdl.handle.net/10451/54960
• Origin: Repositório da Universidade de Lisboa
• Subject(s): Non-alcoholic fatty liver disease (NAFLD); Global public health; Health policy; Liver health; Multiple correspondence analysis; Non-alcoholic steatohepatitis (NASH); Policy preparedness
• Document Type: Journal article
• Language: English
• Contributor(s): Repositório Científico de Acesso Aberto da ULisboa

Description

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.