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A global research priority agenda to advance public health responses to fatty liver disease |
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J Hepatol. 2023 Sep;79(3):618-634. doi: 10.1016/j.jhep.2023.04.035. Epub 2023 Jun 20.
Jeffrey V Lazarus 1, Henry E Mark 2, Alina M Allen 3, Juan Pablo Arab 4, Patrizia Carrieri 5, Mazen Noureddin 6, William Alazawi 7, Naim Alkhouri 8, Saleh A Alqahtani 9, Marco Arrese 10, Ramon Bataller 11, Thomas Berg 12, Paul N Brennan 13, Patrizia Burra 14, Graciela E Castro-Narro 15, Helena Cortez-Pinto 16, Kenneth Cusi 17, Nikos Dedes 18, Ajay Duseja 19, Sven M Francque 20, Hannes Hagström 21, Terry T-K Huang 22, Dana Ivancovsky Wajcman 23, Achim Kautz 24, Christopher J Kopka 25, Aleksander Krag 26, Veronica Miller 27, Philip N Newsome 28, Mary E Rinella 29, Diana Romero 30, Shiv Kumar Sarin 31, Marcelo Silva 32, C Wendy Spearman 33, Emmanuel A Tsochatzis 34, Luca Valenti 35, Marcela Villota-Rivas 23, Shira Zelber-Sagi 36, Jörn M Schattenberg 37, Vincent Wai-Sun Wong 38, Zobair M Younossi 39; Healthy Livers, Healthy Lives Collaborators
Collaborators
- Healthy Livers, Healthy Lives Collaborators:
Jeffrey V Lazarus, Henry E Mark, Alina M Allen, Juan Pablo Arab, Patrizia Carrieri, Mazen Noureddin, William Alazawi, Naim Alkhouri, Saleh A Alqahtani, Marco Arrese, Ramon Bataller, Thomas Berg, Paul N Brennan, Patrizia Burra, Graciela E Castro-Narro, Helena Cortez-Pinto, Kenneth Cusi, Nikos Dedes, Ajay Duseja, Sven M Francque, Hannes Hagström, Terry T-K Huang, Dana Ivancovsky Wajcman, Achim Kautz, Christopher J Kopka, Aleksander Krag, Veronica Miller, Philip N Newsome, Mary E Rinella, Diana Romero, Shiv Kumar Sarin, Marcelo Silva, C Wendy Spearman, Emmanuel A Tsochatzis, Luca Valenti, Marcela Villota-Rivas, Shira Zelber-Sagi, Jörn M Schattenberg, Vincent Wai-Sun Wong, Zobair M Younossi, Fredrik Aberg, Leon Adams, Khalid Al-Naamani, Reda M Albadawy, Zinaida Alexa, Michael Allison, Faisal A Alnaser, Khalid Alswat, Mario Reis Alvares-da-Silva, Domenico Alvaro, Michele Alves-Bezerra, Raul J Andrade, Quentin M Anstee, Yaw Asante Awuku, Oidov Baatarkhuu, Gyorgy Baffy, Shokhista Bakieva, Meena B Bansal, Robert Barouki, Rachel L Batterham, Cynthia Behling, Renata Belfort-DeAguiar, Annalisa Berzigotti, Michael Betel, Cristiana Bianco, Emanuele Bosi, Jerome Boursier, Elizabeth M Brunt, Elisabetta Bugianesi, Christopher J Byrne, Maria Cecilia Cabrera Cabrejos, Stephen Caldwell, Rotonya Carr, Marlen Ivón Castellanos Fernández, Laurent Castera, Maria Gabriela Castillo-López, Cyrielle Caussy, Eira Cerda-Reyes, Antonio Ceriello, Wah-Kheong Chan, Yoosoo Chang, Phunchai Charatcharoenwitthaya, Norberto Chavez-Tapia, Raymond T Chung, Massimo Colombo, Kirsten Coppell, Helma P Cotrim, Antonio Craxi, Javier Crespo, Anuradha Dassanayake, Nicholas O Davidson, Robert De Knegt, Victor de Ledinghen, Münevver Demir, Hailemichael Desalegn, Moises Diago, John F Dillon, Bruce Dimmig, M Ashworth Dirac, Melisa Dirchwolf, Jean-François Dufour, Karel Dvorak, Mattias Ekstedt, Mohamed El-Kassas, Osama M Elsanousi, Ahmed M Elsharkawy, Reda Elwakil, Wayne Eskridge, Mohammed Eslam, Gamal Esmat, Jian-Gao Fan, Maria Lucia Ferraz, Robert Flisiak, Davide Fortin, Yasser Fouad, Scott L Freidman, Michael Fuchs, Adrian Gadano, Amalia Gastaldelli, Anja Geerts, Andreas Geier, Jacob George, Lynn H Gerber, Hasmik Ghazinyan, Liana Gheorghe, Denise Giangola Kile, Marcos Girala, George Goh Boon Bee, Nicolas Goossens, Isabel Graupera, Henning Grønbæk, Saeed Hamid, Vanessa Hebditch, Zachary Henry, Ingrid J Hickman, L Ansley Hobbs, Samantha L Hocking, Wolf Peter Hofmann, Ramazan Idilman, Paula Iruzubieta, Scott Isaacs, Vasily A Isakov, Mona H Ismail, Mohammad H Jamal, Helen Jarvis, Peter Jepsen, François Jornayvaz, K C Sudhamshu, Satoru Kakizaki, Saul Karpen, Takumi Kawaguchi, Shelley E Keating, Yousef Khader, Seung Up Kim, Won Kim, David E Kleiner, Ger Koek, Narcisse Patrice Joseph Komas, Loreta A Kondili, Bart G Koot, Marko Korenjak, Eleni Kotsiliti, Yiannoula Koulla, Carina Kugelmas, Marcelo Kugelmas, Asma Labidi, Naomi F Lange, Joel E Lavine, Mariana Lazo, Nathalie Leite, Han-Chieh Lin, Undram Lkhagvaa, Michelle T Long, Patricio Lopez-Jaramillo, Adelina Lozano, Maria Paula Macedo, Reza Malekzadeh, Giulio Marchesini, Sebastian Marciano, Kim Martinez, Sophia E Martínez Vázquez, Lyudmila Mateva, José M Mato, Charles Mbendi Nlombi, Alexis Gorden McCary, Jeff McIntyre, Martin McKee, Juan M Mendive, Ivana Mikolasevic, Pamela S Miller, Tamara Milovanovic, Terri Milton, Rosalba Moreno-Alcantar, Timothy R Morgan, Ayesha Motala, Jean Muris, Carla Musso, Edna J Nava-González, Francesco Negro, Alexander V Nersesov, Brent A Neuschwander-Tetri, Dafina Nikolova, Suzanne Norris, Katja Novak, Ponsiano Ocama, Janus P Ong, Arlinking Ong-Go, Charles Onyekwere, Martin Padilla, Raluca Pais, Calvin Pan, Arturo Panduro, Manas K Panigrahi, Georgios Papatheodoridis, Imran Paruk, Keyur Patel, Carlos Penha Gonçalves, Marlene Pérez Figueroa, Juanita Pérez-Escobar, Juan M Pericàs, Gianluca Perseghin, Mário Guimarães Pessoa, Salvatore Petta, Claudia Pinto Marques Souza de Oliveira, Dorairaj Prabhakaran, Nikolaos Pyrsopoulous, Atoosa Rabiee, Alnoor Ramji, Vlad Ratziu, Natarajan Ravendhran, Katrina Ray, Michael Roden, Stefano Romeo, Manuel Romero-Gómez, Yaron Rotman, Samir Rouabhia, Ian A Rowe, Shakhlo Sadirova, Maryam Salem Alkhatry, Riina Salupere, Sanjaya K Satapathy, Jeffrey B Schwimmer, Giada Sebastiani, Lynn Seim, Yosuke Seki, Abdel Karim Serme, David Shapiro, Lali Sharvadze, Jonathan E Shaw, Isaac Thom Shawa, Thrivikrama Shenoy, Oren Shibolet, Yusuke Shimakawa, Jay H Shubrook, Shivaram Prasad Singh, Edford Sinkala, Lubomir Skladany, Igor Skrypnyk, Myeong Jun Song, Silvia Sookoian, Kannan Sridharan, Norbert Stefan, Jonathan G Stine, Nikolaos Stratakis, Dhastagir Sultan Sheriff, Shikha S Sundaram, Gianluca Svegliati-Baroni, Mark G Swain, Frank Tacke, Shahrad Taheri, Soek-Siam Tan, Elliot B Tapper, Giovanni Targher, Eugen Tcaciuc, Maja Thiele, Dina Tiniakos, Ieva Tolmane, Aldo Torre, Esther A Torres, Sombat Treeprasertsuk, Michael Trenell, Svetlana Turcan, Adela Turcanu, Jonas Valantinas, Laurens A van Kleef, Jose Antonio Velarde Ruiz Velasco, Mette Vesterhus, Eduardo Vilar-Gomez, Imam Waked, Julia Wattacheril, Heiner Wedemeyer, Fonda Wilkins, José Willemse, Robert J Wong, Yusuf Yilmaz, Hannele Yki-Järvinen, Ming-Lung Yu, Volkan Yumuk, Müjdat Zeybel, Kenneth I Zheng, Ming-Hua Zheng
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Author information
1Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA. Electronic address: Jeffrey.Lazarus@sph.cuny.edu.
2European Association for the Study of the Liver (EASL), Geneva, Switzerland; Independent Consultant, Nottingham, UK.
3Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
4Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada; Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
5Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
6Houston Methodist Hospital, Houston Research Institute, Houston, TX, USA.
7Barts Liver Centre, Blizard Institute, Queen Mary University of London, London, UK.
8Fatty Liver Program, Arizona Liver Health, Phoenix, AZ, USA.
9King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
10Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
11Liver Unit, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
12Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany.
13Division of Hepatology, University of Dundee, Dundee, Scotland, UK.
14Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology and Gastroenterology at the Padua University Hospital, Padua, Italy.
15Department of Hepatology and Transplant, Hospital Médica Sur, Mexico City, Mexico; Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Asociación Latinoamericana para el Estudio del Hígado (ALEH), Santiago, Chile.
16Clinica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
17Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Florida, Gainesville, FL, USA.
18Greek Patients Association, Athens, Greece.
19Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
20Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium; InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
21Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
22CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA; CUNY Center for Systems and Community Design and NYU-CUNY Prevention Research Center, New York, NY, USA.
23Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
24Kautz 5 gUG, Köln, Germany.
25Independent Researcher, Ponte de Lima, Portugal.
26Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
27University California Berkeley School of Public Health, Berkeley, CA, USA.
28National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK.
29Department of Medicine, University of Chicago, Chicago, IL, USA.
30Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
31Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
32Hepatology and Clinical Research Units, Hospital Universitario Austral, Buenos Aires, Argentina.
33Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
34UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.
35Precision Medicine, Biological Resource Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
36School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Department of Gastroenterology, Tel Aviv Medical Centre, Tel Aviv, Israel.
37Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Mainz, Germany.
38The Chinese University of Hong Kong, Hong Kong, China.
39Center for Liver Disease, Inova, Falls Church, VA, USA.
Abstract
Background & aims: An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community.
Methods: Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy.
Results: The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of 'agree' responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement ('agree' + 'somewhat agree'); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% 'agree'), 13 priorities had <80% 'agree', with greater reliance on 'somewhat agree' to achieve >90% combined agreement.
Conclusions: Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community's efforts to advance and accelerate responses to this widespread and fast-growing public health threat.
Impact and implications: An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat.
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