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Advancing the global public health agenda for NAFLD: a consensus statement |
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Nat Rev Gastroenterol Hepatol. 2022 Jan;19(1):60-78.doi: 10.1038/s41575-021-00523-4. Epub 2021 Oct 27.
Jeffrey V Lazarus 1 2, Henry E Mark 3, Quentin M Anstee 4 5, Juan Pablo Arab 6, Rachel L Batterham 7, Laurent Castera 8, Helena Cortez-Pinto 9, Javier Crespo 10, Kenneth Cusi 11, M Ashworth Dirac 12, Sven Francque 13 14, Jacob George 15, Hannes Hagström 16, Terry T-K Huang 17, Mona H Ismail 18, Achim Kautz 19, Shiv Kumar Sarin 20, Rohit Loomba 21 22, Veronica Miller 23, Philip N Newsome 24, Michael Ninburg 25, Ponsiano Ocama 26, Vlad Ratziu 27, Mary Rinella 28, Diana Romero 29, Manuel Romero-Gómez 30, Jörn M Schattenberg 31, Emmanuel A Tsochatzis 32 33, Luca Valenti 34 35, Vincent Wai-Sun Wong 36, Yusuf Yilmaz 37 38, Zobair M Younossi 39, Shira Zelber-Sagi 40 41, NAFLD Consensus Consortium
Collaborators, Affiliations collapse
- NAFLD Consensus Consortium:
Fredrik Åberg, Leon Adams, Maryam Salem Al Khatry, Khalid Al Naamani, Omar Alfaro Murillo, Alina M Allen, Faisal Alnaser, Saleh A Alqahtani, Khalid Alswat, Domenico Alvaro, Raúl J Andrade, Marco Arrese, Yaw Asante Awuku, Motala Ayesha, Oidov Baatarkhuu, Shokhista Bakieva, Rita Basu, Ramon Bataller, Shahinaz Bedri, Emanuele Bosi, Marc Bourliere, Radan Bruha, Elisabetta Bugianesi, Patrizia Burra, Maria Buti, Christopher D Byrne, Jose Luis Calleja, Patrizia Carrieri, Flloyd Carter, Marlen Ivon Castellanos Fernandez, Gabriela Castillo-Lopez, Graciela E Castro-Narro, Henry Lik Yuen Chan, Wah-Kheong Chan, Yoosoo Chang, Massimo Colombo, Kirsten J Coppell, Kathleen Corey, Antonio Craxi, Donna Cryer, Anuradha Dassanayake, Antonieta de Ascenção Soares Martins, Victor de Ledinghen, Stefano DelPrato, Alessandro Demaio, Hailemichael Desalegn, John Dillon, Ajay Duseja, Prabhakaran Dorairaj, Mattias Ekstedt, Mohamed El Kassas, Osama M Elsanousi, Gamal Esmat, Jian-Gao Fan, Nathalie Farpour-Lambert, Robert Flisiak, Yasser Fouad, Michael Fuchs, Rino A Gani, Lynn Gerber, Hasmik Ghazinyan, Liana Gheorghe, George Boon-Bee Goh, Henning Grønbæk, Aghayeva Gulnara, Saeed Hamid, Vanessa Hebditch, Ingrid J Hickman, Samantha L Hocking, Bela Hunyady, Ramazan Idilman, Vasily A Isakov, Mohammad H Jamal, Peter Jepsen, Natacha Jreige Iskandar, Myeong Jun Song, K C Sudhamshu, Satoru Kakizaki, George Kalamitsis, Fasiha Kanwal, Jia-Horng Kao, Lee Kaplan, Takumi Kawaguchi, Yousef Khader, Seung Up Kim, Nicolas Kodjoh, Ger Koek, Kazuhiko Koike, Narcisse Patrice Komas, Marko Korenjak, Marcelo Kugelmas, Asma Labidi, Naomi F Lange, Joel E Lavine, Mariana Lazo, Nancy Lee, Cosmas Rinaldi A Lesmana, Chun-Jen Liu, Michelle T Long, Patricio Lopez-Jaramillo, Reza Malekzadeh, Mamun Al Mahtab, Giulio Marchesini, Rui Marinho, Sophia E Martínez Vázquez, Lyudmila Mateva, Charles Mbendi Nlombi, Pascal Melin, Ivana Mikolasevic, Tamara Milovanovic, Carla Musso, Atsushi Nakajima, Edna Nava, Alexander V Nersesov, Dafina Nikolova, Suzanne Norris, Katja Novak, Jude Oben, Janus P Ong, Charles Onyekwere, George Papatheodoridis, Imran Paruk, Keyur Patel, M Paula Macedo, Carlos Penha-Gonçalves, Marlene Pérez Figueroa, Wolf Peter Hofmann, Salvatore Petta, Claudia Pinto Marques Souza de Oliveira, Puneet Puri, Calvin Q Pan, Marek Rac, Johanna Ralston, Alnoor Ramji, Homie Razavi, Mario Reis Alvares-da-Silva, Stuart Roberts, Michael Roden, Tamsin Rose, Samir Rouabhia, Patrizia Rovere-Querini, Ian A Rowe, Shakhlo Sadirova, Riina Salupere, Tobokalova Saparbu, Raymond Sayegh, Giada Sebastiani, Yosuke Seki, Josefina Selmo,
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Author information
- 1Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain. Jeffrey.Lazarus@isglobal.org.
- 2EASL International Liver Foundation, Geneva, Switzerland. Jeffrey.Lazarus@isglobal.org.
- 3EASL International Liver Foundation, Geneva, Switzerland.
- 4Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
- 5Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
- 6Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
- 7Centre for Obesity Research, University College London and National Institute of Health Research, UCLH Biomedical Research Centre, London, UK.
- 8Department of Hepatology, Hôpital Beaujon, Université de Paris, Paris, France.
- 9Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
- 10Gastroenterology and Heptology Unit, Hospital Universitario Marqués de Valdecilla, Santander, IDIVAL, Santander, Spain.
- 11Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Veterans Health Administration and University of Florida, Gainesville, FL, USA.
- 12Department of Health Metrics Sciences, Department of Family Medicine, University of Washington, Seattle, WA, USA.
- 13Department of Gastroenterology Hepatology, University Hospital Antwerp, Antwerp, Belgium.
- 14Translational Sciences in Inflammation and Immunology TWI2N, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
- 15Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia.
- 16Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
- 17Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.
- 18Division of Gastroenterology, Department of Internal Medicine, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
- 19Kautz5, Köln, Germany.
- 20Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
- 21Department of Medicine, NAFLD Research Center, La Jolla, CA, USA.
- 22Department of Medicine, University of California San Diego, La Jolla, CA, USA.
- 23University of California Berkeley, School of Public Health, Forum for Collaborative Research, Washington, DC, USA.
- 24National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK.
- 25Hepatitis Education Project, Seattle, WA, USA.
- 26Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
- 27Assistance Publique-Hôpitaux de Paris, Hôpital Pitie-Salpetriere, University of Paris, Paris, France.
- 28Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- 29Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
- 30UCM Digestive Diseases, CIBEREHD and IBIS, Virgen del Rocío University Hospital, University of Seville, Seville, Spain.
- 31Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Mainz, Germany.
- 32University College London Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.
- 33Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.
- 34Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
- 35Precision Medicine, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- 36Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
- 37Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey.
- 38Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
- 39Center for Liver Diseases, Inova Medicine, Falls Church, VA, USA.
- 40University of Haifa, Faculty of Social Welfare and Health Sciences, School of Public Health, Mount Carmel, Haifa, Israel.
- 41Department of Gastroenterology, Tel-Aviv Medical Centre, Tel-Aviv, Israel.
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics - from epidemiology, awareness, care and treatment to public health policies and leadership - that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD.
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