The global NAFLD policy review and preparedness index: Are countries ready to address this silent public health challenge?
Authors: Jeffrey V. Lazarus, Henry E. Mark, Marcela Villota-Rivas, Adam Palayew, Patrizia Carrieri, Massimo Colombo, Mattias Ekstedt, Gamal Esmat, Jacob George, Giulio Marchesini, Katja Novak, Ponsiano Ocama, Vlad Ratziu, Homie Razavi, Manuel Romero-Gómez, Marcelo Silva, C. Wendy Spearman, Frank Tacke, Emmanuel A. Tsochatzis, Yusuf Yilmaz, Zobair M. Younossi, Vincent W.-S. Wong, Shira Zelber-Sagi, Helena Cortez-Pinto, Quentin M. Anstee, Samir Rouabhia, Hasmik Ghazinyan, Natacha Jreige Iskandar, Michael Trauner, Gulnara Aghayeva, Flloyd Carter, Kannan Sridharan, Mamun Al Mahtab, Sven Francque, Nicolas Kodjoh, Ruben Muñoz Camacho, Motswedi Anderson, Claudia Pinto Marques Souza de Oliveira, Lyudmila Mateva, Abdel Karim Serme, Antonieta A. Soares Martins, Mark G. Swain, Narcisse Patrice Komas, Ming-Hua Zheng, Patricio Lopez Jaramillo, Omar Alfaro Murillo, Ivana Mikolasevic, Emmelia Vounou, Radan Brůha, Charles Mbendi Nlombi, Maja Thiele, Marlene Perez, Juan José Suárez M, Imam Waked, Riina Salupere, Hailemichael Desalegn, Hannele Yki-Järvinen, Tengiz Tsertsvadze, Lali Sharvadze, Maia Butsashvili, Yaw Asante Awuku, Georgios Papatheodoridis, Bela Hunyady, Einar Stefan Bjornsson, Ajay Duseja, Cosmas Rinaldi A. Lesmana, Reza Malekzadeh, Suzanne Norris, Kazuhiko Koike, Alexander V. Nersesov, Missiani Ochwoto, Mohammad Jamal, Tobokalova Saparbu, Ieva Tolmane, Raymond Sayegh, Dhastagir Sultan Sheriff, Jonas Valantinas, Joseph Weber, Isaac Thom Shawa, Soek-Siam Tan, Sophia E. Martínez Vázquez, Oidov Baatarkhuu, Undram Lkhagvaa, Tsolmon Jadamba, Tahiri Mohammed, K.C Sudhamshu, Kirsten Coppell, Charles Onyekwere, Dafina Nikolova, Mette Vesterhus, Khalid Al-Naamani, Saeed Hamid, Juan Paredes Méndez, María Cecilia Cabrera Cabrejos, Robert Flisiak, Esther A. Torres, Shahrad Taheri, Ki-Chul Sung, Turcanu Adela, Liana Gheorghe, Faisal M. Sanai, Tamara Milovanovic, George Boon Bee Goh, Marek Rac, Anuradha Dassanayake, Shahinaz Bedri Osama, M. Elsanousi, Jean-François Dufour, Jia-Horng Kao, Dilshod Saidi, Sombat Treeprasertsuk, Ger Koek, Asma Labidi, Igor Skrypnyk, Maryam Salem AlKhatry, Shakhlo Sadirova, Shokhista Bakieva, Edford Sinkala
Journal: Journal of Hepatology (2021)

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.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.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.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.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.