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Abstract Details |
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The global NAFLD policy review and preparedness index: Are countries ready to address this silent public health challenge? |
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J Hepatol. 2022 Apr;76(4):771-780. doi: 10.1016/j.jhep.2021.10.025. Epub 2021 Dec 9.
Jeffrey V Lazarus 1, Henry E Mark 2, Marcela Villota-Rivas 3, Adam Palayew 4, Patrizia Carrieri 5, Massimo Colombo 6, Mattias Ekstedt 7, Gamal Esmat 8, Jacob George 9, Giulio Marchesini 10, Katja Novak 11, Ponsiano Ocama 12, Vlad Ratziu 13, Homie Razavi 14, Manuel Romero-Gómez 15, Marcelo Silva 16, C Wendy Spearman 17, Frank Tacke 18, Emmanuel A Tsochatzis 19, Yusuf Yilmaz 20, Zobair M Younossi 21, Vincent W-S Wong 22, Shira Zelber-Sagi 23,
Helena Cortez-Pinto 24, Quentin M Anstee 25, NAFLD policy review collaborators
Collaborators
- NAFLD policy review collaborators:
Samir Rouabhia
26
, Hasmik Ghazinyan
27,
Natacha Jreige Iskandar
28, Michael Trauner
29,
Gulnara Aghayeva
30, Flloyd Carter
31, Kannan Sridharan
32, Mamun Al Mahtab
33, Sven Francque
34, Nicolas Kodjoh
35,
Ruben Muñoz Camacho
36, Motswedi Anderson
37,
Claudia Pinto Marques Souza de Oliveira
38,
Lyudmila Mateva
39, Abdel Karim Serme
40,
Antonieta A Soares Martins
41,
Mark G Swain
42,
Narcisse Patrice Komas
43, Ming-Hua Zheng
44, Patricio Lopez Jaramillo
45, Omar Alfaro Murillo
46,
Ivana Mikolasevic
47, Emmelia Vounou
48, Radan Bruha
49, Charles Mbendi Nlombi
50, Maja Thiele
51, Marlene Perez
52, Juan José
Suárez M
53,
Imam Waked
54, Riina Salupere
55, Hailemichael Desalegn
56, Hannele Yki-Järvinen 57, Tengiz Tsertsvadze 58, Lali Sharvadze 58, Maia Butsashvili 58, Yaw Asante Awuku 59, Georgios Papatheodoridis 60, Bela Hunyady 61, Einar Stefan Bjornsson 62, Ajay Duseja 63, Cosmas Rinaldi A Lesmana 64, Reza Malekzadeh 65, Suzanne Norris 66, Kazuhiko Koike 67, Alexander V Nersesov 68, Missiani Ochwoto 69, Mohammad Jamal 70, Tobokalova Saparbu 71, Ieva Tolmane 72, Raymond Sayegh 73, Dhastagir Sultan Sheriff 74, Jonas Valantinas 75, Joseph Weber 76, Isaac Thom Shawa 77, Soek-Siam Tan 78, Sophia E Martínez Vázquez 79, Oidov Baatarkhuu 80, Undram Lkhagvaa 80, Tsolmon Jadamba 80, Tahiri Mohammed 81, K C Sudhamshu 82, Kirsten Coppell 83
, Charles Onyekwere 84,&nbs |
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Author information
- 1Barcelona 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.
- 2EASL International Liver Foundation, Geneva, Switzerland.
- 3Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; EASL International Liver Foundation, Geneva, Switzerland.
- 4EASL International Liver Foundation, Geneva, Switzerland; Department of Epidemiology, University of Washington, Seattle, USA.
- 5Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
- 6EASL International Liver Foundation, Geneva, Switzerland; Liver Center, IRCCS San Raffaele Hospital, Milan, Italy.
- 7Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- 8Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
- 9Storr Liver Centre, Westmead Institute of Medical Research, Westmead Hospital and University of Sydney, Sydney, Australia.
- 10IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy.
- 11University Medical Center Ljubljana, Department of Gastroenterology, Ljubljana, Slovenia.
- 12Makerere University College of Health Sciences, Kampala, Uganda.
- 13Pitie-Salpetriere Hospital, Department of Hepatology University Paris, Paris, France.
- 14Center for Disease Analysis Foundation, Colorado, USA.
- 15Digestive Diseases and ciberehd. Virgen del Rocío University Hospital. Institute of Biomedicine of Seville, University of Seville, Seville, Spain.
- 16Hepatology and Liver Transplant Units, Hospital Universitario Austral, Buenos Aires, Argentina.
- 17Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
- 18Charité Universitätsmedizin Berlin, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Charité Mitte, 13353 Berlin, Germany.
- 19UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.
- 20Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey; Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
- 21Center for Liver Diseases, Inova Medicine, Falls Church, Virginia, USA.
- 22Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
- 23University 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.
- 24Clinica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
- 25Translational & 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.
- 26Algeria.
- 27Armenia.
- 28Aruba.
- 29Austria.
- 30Azerbaijan.
- 31The Bahamas.
- 32Bahrain.
- 33Bangladesh.
- 34Belgium.
- 35Benin.
- 36Bolivia.
- 37Botswana.
- 38Brazil.
- 39Bulgaria.
- 40Burkina Faso.
- 41Cabo Verde.
- 42Canada.
- 43Central African Republic.
- 44China.
- 45Colombia.
- 46Costa Rica.
- 47Croatia.
- 48Cyprus.
- 49Czech Republic.
- 50Democratic Republic of Congo.
- 51Denmark.
- 52Dominican Republic.
- 53Ecuador.
- 54Egypt.
- 55Estonia.
- 56Ethiopia.
- 57Finland.
- 58Georgia (co-leads).
- 59Ghana.
- 60Greece.
- 61Hungary.
- 62Iceland.
- 63India.
- 64Indonesia.
- 65Iran (Islamic Republic of).
- 66Ireland.
- 67Japan.
- 68Kazakhstan.
- 69Kenya.
- 70Kuwait.
- 71Kyrgyzstan.
- 72Latvia.
- 73Lebanon.
- 74Libya.
- 75Lithuania.
- 76Luxembourg.
- 77Malawi.
- 78Malaysia.
- 79Mexico.
- 80Mongolia (co-leads).
- 81Morocco.
- 82Nepal.
- 83New Zealand.
- 84Nigeria.
- 85North Macedonia.
- 86Norway.
- 87Oman.
- 88Pakistan.
- 89Peru (co-leads).
- 90Poland.
- 91Puerto Rico.
- 92Qatar.
- 93Republic of Korea.
- 94Republic of Moldova.
- 95Romania.
- 96Saudi Arabia.
- 97Serbia.
- 98Singapore.
- 99Slovak Republic.
- 100Sri Lanka.
- 101Sudan (co-leads).
- 102Switzerland.
- 103Taiwan.
- 104Tajikistan.
- 105Thailand.
- 106The Netherlands.
- 107Tunisia.
- 108Ukraine.
- 109United Arab Emirates.
- 110Uzbekistan (co-leads).
- 111Zambia.
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.
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