The global NAFLD policy review and preparedness index: Are countries ready to address this silent public health challenge?
Lazarus J.V. Mark H.E. Villota-Rivas M. Palayew A. Carrieri P. Colombo M. Ekstedt M. Esmat G. George J. Marchesini G. Novak K. Ocama P. Ratziu V. Razavi H. Romero-Gómez M. Silva M. Spearman C.W. Tacke F. Tsochatzis E.A. Yilmaz Y. Younossi Z.M. Wong V.W.-S. Zelber-Sagi S. Cortez-Pinto H. Anstee Q.M. Rouabhia S. Ghazinyan H. Iskandar N.J. Trauner M. Aghayeva G. Carter F. Sridharan K. Al Mahtab M. Francque S. Kodjoh N. Camacho R.M. Anderson M. Marques Souza de Oliveira C.P. Mateva L. Serme A.K. Soares Martins A.A. Swain M.G. Komas N.P. Zheng M.-H. Jaramillo P.L. Murillo O.A. Mikolasevic I. Vounou E. Brůha R. Nlombi C.M. Thiele M. Perez M. Suárez M J.J. Waked I. Salupere R. Desalegn H. Yki-Järvinen H. Tsertsvadze T. Sharvadze L. Butsashvili M. Awuku Y.A. Papatheodoridis G. Hunyady B. Bjornsson E.S. Duseja A. Lesmana C.R.A. Malekzadeh R. Norris S. Koike K. Nersesov A.V. Ochwoto M. Jamal M. Saparbu T. Tolmane I. Sayegh R. Sheriff D.S. Valantinas J. Weber J. Shawa I.T. Tan S.-S. Martínez Vázquez S.E. Baatarkhuu O. Lkhagvaa U. Jadamba T. Mohammed T. Sudhamshu K.C. Coppell K. Onyekwere C. Nikolova D. Vesterhus M. Al-Naamani K. Hamid S. Méndez J.P. Cabrera Cabrejos M.C. Flisiak R. Torres E.A. Taheri S. Sung K.-C. Adela T. Gheorghe L. Sanai F.M. Milovanovic T. Bee Goh G.B. Rac M. Dassanayake A. Osama S.B. Elsanousi M. Dufour J.-F. Kao J.-H. Saidi D. Treeprasertsuk S. Koek G. Labidi A. Skrypnyk I. AlKhatry M.S. Sadirova S. Bakieva S. Sinkala E.
April 2022Elsevier B.V.
Journal of Hepatology
2022#76Issue 4771 - 780 pp.
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.
global public health , health policy , liver health , multiple correspondence analysis , Non-alcoholic fatty liver disease (NAFLD) , non-alcoholic steatohepatitis (NASH) , policy preparedness
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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
Department of Epidemiology, University of Washington, Seattle, United States
Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de lInformation Médicale, ISSPAM, Marseille, France
Liver Center, IRCCS San Raffaele Hospital, Milan, Italy
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Storr Liver Centre, Westmead Institute of Medical Research, Westmead Hospital and University of Sydney, Sydney, Australia
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Università, degli Studi di Bologna, Bologna, Italy
University Medical Center Ljubljana, Department of Gastroenterology, Ljubljana, Slovenia
Makerere University College of Health Sciences, Kampala, Uganda
Pitie-Salpetriere Hospital, Department of Hepatology University Paris, Paris, France
Center for Disease Analysis Foundation, CO, United States
Digestive Diseases and ciberehd. Virgen del Rocío University Hospital. Institute of Biomedicine of Seville, University of Seville, Seville, Spain
Hepatology and Liver Transplant Units, Hospital Universitario Austral, Buenos Aires, Argentina
Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
Charité Universitätsmedizin Berlin, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, 13353, Germany
UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, UK, London, United Kingdom
Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey
Center for Liver Diseases, Inova Medicine, Falls Church, VA, United States
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
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
Clinica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
Algeria
Armenia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Benin
Bolivia
Botswana
Brazil
Bulgaria
Burkina Faso
Cape Verde
Canada
Central African Republic
China
Colombia
Costa Rica
Croatia
Cyprus
Czech Republic
Congo
Denmark
Dominican Republic
Ecuador
Egypt
Estonia
Ethiopia
Finland
Georgia
Ghana
Greece
Hungary
Iceland
India
Indonesia
Iran
Ireland
Japan
Kazakhstan
Kenya
Kuwait
Kyrgyzstan
Latvia
Lebanon
Libya
Lithuania
Luxembourg
Malawi
Malaysia
Mexico
Mongolia
Morocco
Nepal
New Zealand
Nigeria
North Macedonia
Norway
Oman
Pakistan
Peru
Poland
Puerto Rico
Qatar
South Korea
Moldova
Romania
Saudi Arabia
Serbia
Singapore
Slovakia
Sri Lanka
Sudan
Switzerland
Taiwan
Tajikistan
Thailand
Netherlands
Tunisia
Ukraine
United Arab Emirates
Uzbekistan
Zambia
Barcelona Institute for Global Health (ISGlobal)
EASL International Liver Foundation
Faculty of Medicine
Department of Epidemiology
Aix Marseille Univ
Liver Center
Department of Health
Endemic Medicine and Hepatology Department
Storr Liver Centre
IRCCS Azienda Ospedaliero-Universitaria di Bologna
Università
University Medical Center Ljubljana
Makerere University College of Health Sciences
Pitie-Salpetriere Hospital
Center for Disease Analysis Foundation
Digestive Diseases and ciberehd. Virgen del Rocío University Hospital. Institute of Biomedicine of Seville
Hepatology and Liver Transplant Units
Division of Hepatology
Charité Universitätsmedizin Berlin
UCL Institute for Liver and Digestive Health
Department of Gastroenterology
Liver Research Unit
Center for Liver Diseases
Department of Medicine and Therapeutics
University of Haifa
Department of Gastroenterology
Clinica Universitária de Gastrenterologia
Translational & Clinical Research Institute
Newcastle NIHR Biomedical Research Centre
Algeria
Armenia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Benin
Bolivia
Botswana
Brazil
Bulgaria
Burkina Faso
Cape Verde
Canada
Central African Republic
China
Colombia
Costa Rica
Croatia
Cyprus
Czech Republic
Congo
Denmark
Dominican Republic
Ecuador
Egypt
Estonia
Ethiopia
Finland
Georgia
Ghana
Greece
Hungary
Iceland
India
Indonesia
Iran
Ireland
Japan
Kazakhstan
Kenya
Kuwait
Kyrgyzstan
Latvia
Lebanon
Libya
Lithuania
Luxembourg
Malawi
Malaysia
Mexico
Mongolia
Morocco
Nepal
New Zealand
Nigeria
North Macedonia
Norway
Oman
Pakistan
Peru
Poland
Puerto Rico
Qatar
South Korea
Moldova
Romania
Saudi Arabia
Serbia
Singapore
Slovakia
Sri Lanka
Sudan
Switzerland
Taiwan
Tajikistan
Thailand
Netherlands
Tunisia
Ukraine
United Arab Emirates
Uzbekistan
Zambia
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