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. · Journal of Hepatology (2022) · DOI: 10.1016/j.jhep.2021.10.025

Resumen

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.