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1. A global research priority agenda to advance public health responses to fatty liver disease

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Lazarus, J, Mark, H, Allen, A, Arab, J, Carrieri, P, Noureddin, M, Alazawi, W, Alkhouri, N, Alqahtani, S, Arrese, M, Bataller, R, Berg, T, Brennan, P, Burra, P, Castro-Narro, G, Cortez-Pinto, H, Cusi, K, Dedes, N, Duseja, A, Francque, S, Hagstrom, H, Huang, T, Wajcman, D, Kautz, A, Kopka, C, Krag, A, Miller, V, Newsome, P, Rinella, M, Romero, D, Sarin, S, Silva, M, Spearman, C, Tsochatzis, E, Valenti, L, Villota-Rivas, M, Zelber-Sagi, S, Schattenberg, J, Wong, V, Younossi, Z, Aberg, F, Adams, L, Al-Naamani, K, Albadawy, R, Alexa, Z, Allison, M, Alnaser, F, Alswat, K, Alvares-da-Silva, M, Alvaro, D, Alves-Bezerra, M, Andrade, R, Anstee, Q, Awuku, Y, Baatarkhuu, O, Baffy, G, Bakieva, S, Bansal, M, Barouki, R, Batterham, R, Behling, C, Belfort-DeAguiar, R, Berzigotti, A, Betel, M, Bianco, C, Bosi, E, Boursier, J, Brunt, E, Bugianesi, E, Byrne, C, Cabrera Cabrejos, M, Caldwell, S, Carr, R, Castellanos Fernandez, M, Castera, L, Castillo-Lopez, M, Caussy, C, Cerda-Reyes, E, Ceriello, A, Chan, W, Chang, Y, Charatcharoenwitthaya, P, Chavez-Tapia, N, Chung, R, Colombo, M, Coppell, K, Cotrim, H, Craxi, A, Crespo, J, Dassanayake, A, Davidson, N, De Knegt, R, de Ledinghen, V, Demir, M, Desalegn, H, Diago, M, Dillon, J, Dimmig, B, Dirac, M, Dirchwolf, M, Dufour, J, Dvorak, K, Ekstedt, M, El-Kassas, M, Elsanousi, O, Elsharkawy, A, Elwakil, R, Eskridge, W, Eslam, M, Esmat, G, Fan, J, Ferraz, M, Flisiak, R, Fortin, D, Fouad, Y, Freidman, S, Fuchs, M, Gadano, A, Gastaldelli, A, Geerts, A, Geier, A, George, J, Gerber, L, Ghazinyan, H, Gheorghe, L, Kile, D, Girala, M, Boon Bee, G, Goossens, N, Graupera, I, Gronbaek, H, Hamid, S, Hebditch, V, Henry, Z, Hickman, I, Hobbs, L, Hocking, S, Hofmann, W, Idilman, R, Iruzubieta, P, Isaacs, S, Isakov, V, Ismail, M, Jamal, M, Jarvis, H, Jepsen, P, Jornayvaz, F, Sudhamshu, K, Kakizaki, S, Karpen, S, Kawaguchi, T, Keating, S, Khader, Y, Kim, S, Kim, W, Kleiner, D, Koek, G, Joseph Komas, N, Kondili, L, Koot, B, Korenjak, M, Kotsiliti, E, Koulla, Y, Kugelmas, C, Kugelmas, M, Labidi, A, Lange, N, Lavine, J, Lazo, M, Leite, N, Lin, H, Lkhagvaa, U, Long, M, Lopez-Jaramillo, P, Lozano, A, Macedo, M, Malekzadeh, R, Marchesini, G, Marciano, S, Martinez, K, Martinez Vazquez, S, Mateva, L, Mato, J, Nlombi, C, Mccary, A, Mcintyre, J, Mckee, M, Mendive, J, Mikolasevic, I, Miller, P, Milovanovic, T, Milton, T, Moreno-Alcantar, R, Morgan, T, Motala, A, Muris, J, Musso, C, Nava-Gonzalez, E, Negro, F, Nersesov, A, Neuschwander-Tetri, B, Nikolova, D, Norris, S, Novak, K, Ocama, P, Ong, J, Ong-Go, A, Onyekwere, C, Padilla, M, Pais, R, Pan, C, Panduro, A, Panigrahi, M, Papatheodoridis, G, Paruk, I, Patel, K, Goncalves, C, Figueroa, M, Perez-Escobar, J, Pericas, J, Perseghin, G, Pessoa, M, Petta, S, Marques Souza de Oliveira, C, Prabhakaran, D, Pyrsopoulous, N, Rabiee, A, Ramji, A, Ratziu, V, Ravendhran, N, Ray, K, Roden, M, Romeo, S, Romero-Gomez, M, Rotman, Y, Rouabhia, S, Rowe, I, Sadirova, S, Alkhatry, M, Salupere, R, Satapathy, S, Schwimmer, J, Sebastiani, G, Seim, L, Seki, Y, Serme, A, Shapiro, D, Sharvadze, L, Shaw, J, Shawa, I, Shenoy, T, Shibolet, O, Shimakawa, Y, Shubrook, J, Singh, S, Sinkala, E, Skladany, L, Skrypnyk, I, Song, M, Sookoian, S, Sridharan, K, Stefan, N, Stine, J, Stratakis, N, Sheriff, D, Sundaram, S, Svegliati-Baroni, G, Swain, M, Tacke, F, Taheri, S, Tan, S, Tapper, E, Targher, G, Tcaciuc, E, Thiele, M, Tiniakos, D, Tolmane, I, Torre, A, Torres, E, Treeprasertsuk, S, Trenell, M, Turcan, S, Turcanu, A, Valantinas, J, van Kleef, L, Velarde Ruiz Velasco, J, Vesterhus, M, Vilar-Gomez, E, Waked, I, Wattacheril, J, Wedemeyer, H, Wilkins, F, Willemse, J, Wong, R, Yilmaz, Y, Yki-Jarvinen, H, Yu, M, Yumuk, V, Zeybel, M, Zheng, K, Zheng, M, Lazarus J. V., Mark H. E., Allen A. M., Arab J. P., Carrieri P., Noureddin M., Alazawi W., Alkhouri N., Alqahtani S. A., Arrese M., Bataller R., Berg T., Brennan P. N., Burra P., Castro-Narro G. E., Cortez-Pinto H., Cusi K., Dedes N., Duseja A., Francque S. M., Hagstrom H., Huang T. T. -K., Wajcman D. I., Kautz A., Kopka C. J., Krag A., Miller V., Newsome P. N., Rinella M. E., Romero D., Sarin S. K., Silva M., Spearman C. W., Tsochatzis E. A., Valenti L., Villota-Rivas M., Zelber-Sagi S., Schattenberg J. M., Wong V. W. -S., Younossi Z. M., Aberg F., Adams L., Al-Naamani K., Albadawy R. M., Alexa Z., Allison M., Alnaser F. A., Alswat K., Alvares-da-Silva M. R., Alvaro D., Alves-Bezerra M., Andrade R. J., Anstee Q. M., Awuku Y. A., Baatarkhuu O., Baffy G., Bakieva S., Bansal M. B., Barouki R., Batterham R. L., Behling C., Belfort-DeAguiar R., Berzigotti A., Betel M., Bianco C., Bosi E., Boursier J., Brunt E. M., Bugianesi E., Byrne C. J., Cabrera Cabrejos M. C., Caldwell S., Carr R., Castellanos Fernandez M. I., Castera L., Castillo-Lopez M. G., Caussy C., Cerda-Reyes E., Ceriello A., Chan W. -K., Chang Y., Charatcharoenwitthaya P., Chavez-Tapia N., Chung R. T., Colombo M., Coppell K., Cotrim H. P., Craxi A., Crespo J., Dassanayake A., Davidson N. O., De Knegt R., de Ledinghen V., Demir M., Desalegn H., Diago M., Dillon J. F., Dimmig B., Dirac M. A., Dirchwolf M., Dufour J. -F., Dvorak K., Ekstedt M., El-Kassas M., Elsanousi O. M., Elsharkawy A. M., Elwakil R., Eskridge W., Eslam M., Esmat G., Fan J. -G., Ferraz M. L., Flisiak R., Fortin D., Fouad Y., Freidman S. L., Fuchs M., Gadano A., Gastaldelli A., Geerts A., Geier A., George J., Gerber L. H., Ghazinyan H., Gheorghe L., Kile D. G., Girala M., Boon Bee G. G., Goossens N., Graupera I., Gronbaek H., Hamid S., Hebditch V., Henry Z., Hickman I. J., Hobbs L. A., Hocking S. L., Hofmann W. P., Idilman R., Iruzubieta P., Isaacs S., Isakov V. A., Ismail M. H., Jamal M. H., Jarvis H., Jepsen P., Jornayvaz F., Sudhamshu K. C., Kakizaki S., Karpen S., Kawaguchi T., Keating S. E., Khader Y., Kim S. U., Kim W., Kleiner D. E., Koek G., Joseph Komas N. P., Kondili L. A., Koot B. G., Korenjak M., Kotsiliti E., Koulla Y., Kugelmas C., Kugelmas M., Labidi A., Lange N. F., Lavine J. E., Lazo M., Leite N., Lin H. -C., Lkhagvaa U., Long M. T., Lopez-Jaramillo P., Lozano A., Macedo M. P., Malekzadeh R., Marchesini G., Marciano S., Martinez K., Martinez Vazquez S. E., Mateva L., Mato J. M., Nlombi C. M., McCary A. G., McIntyre J., McKee M., Mendive J. M., Mikolasevic I., Miller P. S., Milovanovic T., Milton T., Moreno-Alcantar R., Morgan T. R., Motala A., Muris J., Musso C., Nava-Gonzalez E. J., Negro F., Nersesov A. V., Neuschwander-Tetri B. A., Nikolova D., Norris S., Novak K., Ocama P., Ong J. P., Ong-Go A., Onyekwere C., Padilla M., Pais R., Pan C., Panduro A., Panigrahi M. K., Papatheodoridis G., Paruk I., Patel K., Goncalves C. P., Figueroa M. P., Perez-Escobar J., Pericas J. M., Perseghin G., Pessoa M. G., Petta S., Marques Souza de Oliveira C. P., Prabhakaran D., Pyrsopoulous N., Rabiee A., Ramji A., Ratziu V., Ravendhran N., Ray K., Roden M., Romeo S., Romero-Gomez M., Rotman Y., Rouabhia S., Rowe I. A., Sadirova S., Alkhatry M. S., Salupere R., Satapathy S. K., Schwimmer J. B., Sebastiani G., Seim L., Seki Y., Serme A. K., Shapiro D., Sharvadze L., Shaw J. E., Shawa I. T., Shenoy T., Shibolet O., Shimakawa Y., Shubrook J. H., Singh S. P., Sinkala E., Skladany L., Skrypnyk I., Song M. J., Sookoian S., Sridharan K., Stefan N., Stine J. G., Stratakis N., Sheriff D. S., Sundaram S. S., Svegliati-Baroni G., Swain M. G., Tacke F., Taheri S., Tan S. -S., Tapper E. B., Targher G., Tcaciuc E., Thiele M., Tiniakos D., Tolmane I., Torre A., Torres E. A., Treeprasertsuk S., Trenell M., Turcan S., Turcanu A., Valantinas J., van Kleef L. A., Velarde Ruiz Velasco J. A., Vesterhus M., Vilar-Gomez E., Waked I., Wattacheril J., Wedemeyer H., Wilkins F., Willemse J., Wong R. J., Yilmaz Y., Yki-Jarvinen H., Yu M. -L., Yumuk V., Zeybel M., Zheng K. I., Zheng M. -H., Lazarus, J, Mark, H, Allen, A, Arab, J, Carrieri, P, Noureddin, M, Alazawi, W, Alkhouri, N, Alqahtani, S, Arrese, M, Bataller, R, Berg, T, Brennan, P, Burra, P, Castro-Narro, G, Cortez-Pinto, H, Cusi, K, Dedes, N, Duseja, A, Francque, S, Hagstrom, H, Huang, T, Wajcman, D, Kautz, A, Kopka, C, Krag, A, Miller, V, Newsome, P, Rinella, M, Romero, D, Sarin, S, Silva, M, Spearman, C, Tsochatzis, E, Valenti, L, Villota-Rivas, M, Zelber-Sagi, S, Schattenberg, J, Wong, V, Younossi, Z, Aberg, F, Adams, L, Al-Naamani, K, Albadawy, R, Alexa, Z, Allison, M, Alnaser, F, Alswat, K, Alvares-da-Silva, M, Alvaro, D, Alves-Bezerra, M, Andrade, R, Anstee, Q, Awuku, Y, Baatarkhuu, O, Baffy, G, Bakieva, S, Bansal, M, Barouki, R, Batterham, R, Behling, C, Belfort-DeAguiar, R, Berzigotti, A, Betel, M, Bianco, C, Bosi, E, Boursier, J, Brunt, E, Bugianesi, E, Byrne, C, Cabrera Cabrejos, M, Caldwell, S, Carr, R, Castellanos Fernandez, M, Castera, L, Castillo-Lopez, M, Caussy, C, Cerda-Reyes, E, Ceriello, A, Chan, W, Chang, Y, Charatcharoenwitthaya, P, Chavez-Tapia, N, Chung, R, Colombo, M, Coppell, K, Cotrim, H, Craxi, A, Crespo, J, Dassanayake, A, Davidson, N, De Knegt, R, de Ledinghen, V, Demir, M, Desalegn, H, Diago, M, Dillon, J, Dimmig, B, Dirac, M, Dirchwolf, M, Dufour, J, Dvorak, K, Ekstedt, M, El-Kassas, M, Elsanousi, O, Elsharkawy, A, Elwakil, R, Eskridge, W, Eslam, M, Esmat, G, Fan, J, Ferraz, M, Flisiak, R, Fortin, D, Fouad, Y, Freidman, S, Fuchs, M, Gadano, A, Gastaldelli, A, Geerts, A, Geier, A, George, J, Gerber, L, Ghazinyan, H, Gheorghe, L, Kile, D, Girala, M, Boon Bee, G, Goossens, N, Graupera, I, Gronbaek, H, Hamid, S, Hebditch, V, Henry, Z, Hickman, I, Hobbs, L, Hocking, S, Hofmann, W, Idilman, R, Iruzubieta, P, Isaacs, S, Isakov, V, Ismail, M, Jamal, M, Jarvis, H, Jepsen, P, Jornayvaz, F, Sudhamshu, K, Kakizaki, S, Karpen, S, Kawaguchi, T, Keating, S, Khader, Y, Kim, S, Kim, W, Kleiner, D, Koek, G, Joseph Komas, N, Kondili, L, Koot, B, Korenjak, M, Kotsiliti, E, Koulla, Y, Kugelmas, C, Kugelmas, M, Labidi, A, Lange, N, Lavine, J, Lazo, M, Leite, N, Lin, H, Lkhagvaa, U, Long, M, Lopez-Jaramillo, P, Lozano, A, Macedo, M, Malekzadeh, R, Marchesini, G, Marciano, S, Martinez, K, Martinez Vazquez, S, Mateva, L, Mato, J, Nlombi, C, Mccary, A, Mcintyre, J, Mckee, M, Mendive, J, Mikolasevic, I, Miller, P, Milovanovic, T, Milton, T, Moreno-Alcantar, R, Morgan, T, Motala, A, Muris, J, Musso, C, Nava-Gonzalez, E, Negro, F, Nersesov, A, Neuschwander-Tetri, B, Nikolova, D, Norris, S, Novak, K, Ocama, P, Ong, J, Ong-Go, A, Onyekwere, C, Padilla, M, Pais, R, Pan, C, Panduro, A, Panigrahi, M, Papatheodoridis, G, Paruk, I, Patel, K, Goncalves, C, Figueroa, M, Perez-Escobar, J, Pericas, J, Perseghin, G, Pessoa, M, Petta, S, Marques Souza de Oliveira, C, Prabhakaran, D, Pyrsopoulous, N, Rabiee, A, Ramji, A, Ratziu, V, Ravendhran, N, Ray, K, Roden, M, Romeo, S, Romero-Gomez, M, Rotman, Y, Rouabhia, S, Rowe, I, Sadirova, S, Alkhatry, M, Salupere, R, Satapathy, S, Schwimmer, J, Sebastiani, G, Seim, L, Seki, Y, Serme, A, Shapiro, D, Sharvadze, L, Shaw, J, Shawa, I, Shenoy, T, Shibolet, O, Shimakawa, Y, Shubrook, J, Singh, S, Sinkala, E, Skladany, L, Skrypnyk, I, Song, M, Sookoian, S, Sridharan, K, Stefan, N, Stine, J, Stratakis, N, Sheriff, D, Sundaram, S, Svegliati-Baroni, G, Swain, M, Tacke, F, Taheri, S, Tan, S, Tapper, E, Targher, G, Tcaciuc, E, Thiele, M, Tiniakos, D, Tolmane, I, Torre, A, Torres, E, Treeprasertsuk, S, Trenell, M, Turcan, S, Turcanu, A, Valantinas, J, van Kleef, L, Velarde Ruiz Velasco, J, Vesterhus, M, Vilar-Gomez, E, Waked, I, Wattacheril, J, Wedemeyer, H, Wilkins, F, Willemse, J, Wong, R, Yilmaz, Y, Yki-Jarvinen, H, Yu, M, Yumuk, V, Zeybel, M, Zheng, K, Zheng, M, Lazarus J. V., Mark H. E., Allen A. M., Arab J. P., Carrieri P., Noureddin M., Alazawi W., Alkhouri N., Alqahtani S. A., Arrese M., Bataller R., Berg T., Brennan P. N., Burra P., Castro-Narro G. E., Cortez-Pinto H., Cusi K., Dedes N., Duseja A., Francque S. M., Hagstrom H., Huang T. T. -K., Wajcman D. I., Kautz A., Kopka C. J., Krag A., Miller V., Newsome P. N., Rinella M. E., Romero D., Sarin S. K., Silva M., Spearman C. W., Tsochatzis E. A., Valenti L., Villota-Rivas M., Zelber-Sagi S., Schattenberg J. M., Wong V. W. -S., Younossi Z. M., Aberg F., Adams L., Al-Naamani K., Albadawy R. M., Alexa Z., Allison M., Alnaser F. A., Alswat K., Alvares-da-Silva M. R., Alvaro D., Alves-Bezerra M., Andrade R. J., Anstee Q. M., Awuku Y. A., Baatarkhuu O., Baffy G., Bakieva S., Bansal M. B., Barouki R., Batterham R. L., Behling C., Belfort-DeAguiar R., Berzigotti A., Betel M., Bianco C., Bosi E., Boursier J., Brunt E. M., Bugianesi E., Byrne C. J., Cabrera Cabrejos M. C., Caldwell S., Carr R., Castellanos Fernandez M. I., Castera L., Castillo-Lopez M. G., Caussy C., Cerda-Reyes E., Ceriello A., Chan W. -K., Chang Y., Charatcharoenwitthaya P., Chavez-Tapia N., Chung R. T., Colombo M., Coppell K., Cotrim H. P., Craxi A., Crespo J., Dassanayake A., Davidson N. O., De Knegt R., de Ledinghen V., Demir M., Desalegn H., Diago M., Dillon J. F., Dimmig B., Dirac M. A., Dirchwolf M., Dufour J. -F., Dvorak K., Ekstedt M., El-Kassas M., Elsanousi O. M., Elsharkawy A. M., Elwakil R., Eskridge W., Eslam M., Esmat G., Fan J. -G., Ferraz M. L., Flisiak R., Fortin D., Fouad Y., Freidman S. L., Fuchs M., Gadano A., Gastaldelli A., Geerts A., Geier A., George J., Gerber L. H., Ghazinyan H., Gheorghe L., Kile D. G., Girala M., Boon Bee G. G., Goossens N., Graupera I., Gronbaek H., Hamid S., Hebditch V., Henry Z., Hickman I. J., Hobbs L. A., Hocking S. L., Hofmann W. P., Idilman R., Iruzubieta P., Isaacs S., Isakov V. A., Ismail M. H., Jamal M. H., Jarvis H., Jepsen P., Jornayvaz F., Sudhamshu K. C., Kakizaki S., Karpen S., Kawaguchi T., Keating S. E., Khader Y., Kim S. U., Kim W., Kleiner D. E., Koek G., Joseph Komas N. P., Kondili L. A., Koot B. G., Korenjak M., Kotsiliti E., Koulla Y., Kugelmas C., Kugelmas M., Labidi A., Lange N. F., Lavine J. E., Lazo M., Leite N., Lin H. -C., Lkhagvaa U., Long M. T., Lopez-Jaramillo P., Lozano A., Macedo M. P., Malekzadeh R., Marchesini G., Marciano S., Martinez K., Martinez Vazquez S. E., Mateva L., Mato J. M., Nlombi C. M., McCary A. G., McIntyre J., McKee M., Mendive J. M., Mikolasevic I., Miller P. S., Milovanovic T., Milton T., Moreno-Alcantar R., Morgan T. R., Motala A., Muris J., Musso C., Nava-Gonzalez E. J., Negro F., Nersesov A. V., Neuschwander-Tetri B. A., Nikolova D., Norris S., Novak K., Ocama P., Ong J. P., Ong-Go A., Onyekwere C., Padilla M., Pais R., Pan C., Panduro A., Panigrahi M. K., Papatheodoridis G., Paruk I., Patel K., Goncalves C. P., Figueroa M. P., Perez-Escobar J., Pericas J. M., Perseghin G., Pessoa M. G., Petta S., Marques Souza de Oliveira C. P., Prabhakaran D., Pyrsopoulous N., Rabiee A., Ramji A., Ratziu V., Ravendhran N., Ray K., Roden M., Romeo S., Romero-Gomez M., Rotman Y., Rouabhia S., Rowe I. A., Sadirova S., Alkhatry M. S., Salupere R., Satapathy S. K., Schwimmer J. B., Sebastiani G., Seim L., Seki Y., Serme A. K., Shapiro D., Sharvadze L., Shaw J. E., Shawa I. T., Shenoy T., Shibolet O., Shimakawa Y., Shubrook J. H., Singh S. P., Sinkala E., Skladany L., Skrypnyk I., Song M. J., Sookoian S., Sridharan K., Stefan N., Stine J. G., Stratakis N., Sheriff D. S., Sundaram S. S., Svegliati-Baroni G., Swain M. G., Tacke F., Taheri S., Tan S. -S., Tapper E. B., Targher G., Tcaciuc E., Thiele M., Tiniakos D., Tolmane I., Torre A., Torres E. A., Treeprasertsuk S., Trenell M., Turcan S., Turcanu A., Valantinas J., van Kleef L. A., Velarde Ruiz Velasco J. A., Vesterhus M., Vilar-Gomez E., Waked I., Wattacheril J., Wedemeyer H., Wilkins F., Willemse J., Wong R. J., Yilmaz Y., Yki-Jarvinen H., Yu M. -L., Yumuk V., Zeybel M., Zheng K. I., and Zheng M. -H.

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 [removed]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% o

Published
2023

2. Managing implementation of change

Author

Sanders, Steve R. and Eskridge, W. Frank

Subjects
Engineering firms -- Management, Management -- Methods, Business, Engineering and manufacturing industries
Abstract

The effectiveness of the different implementation strategies being employed by various engineering and design firms is strongly dependent on the leadership capabilities of the organizations' managers and the level of participation of the employees. The managers should motivate their people to improve the quality of their work by asking them to participate in the planning and management aspects of the firm's projects. This wil develop trust among the personnel of the organization, thereby, resulting in a more efficient work force.

Published
1993

5. The impact of stigma on quality of life and liver disease burden among patients with nonalcoholic fatty liver disease.

Author

Younossi ZM, AlQahtani SA, Funuyet-Salas J, Romero-Gómez M, Yilmaz Y, Keklikkiran C, Alswat K, Yu ML, Liu CJ, Fan JG, Zheng MH, Burra P, Francque SM, Castera L, Schattenberg JM, Newsome PN, Allen AM, El-Kassas M, Treeprasertsuk S, Hameed S, Wai-Sun Wong V, Zelber-Sagi S, Takahashi H, Kawaguchi T, Castellanos Fernández MI, Duseja A, Arrese M, Rinella M, Singal AK, Gordon SC, Fuchs M, Eskridge W, Alkhouri N, Cusi K, Loomba R, Ranagan J, Kautz A, Ong JP, Kugelmas M, Eguchi Y, Diago M, Gerber L, Lam B, Fornaresio L, Nader F, Spearman CW, Roberts SK, Chan WK, Silva M, Racila A, Golabi P, Ananchuensook P, Henry L, Stepanova M, Carrieri P, and Lazarus JV

Abstract

Background & Aims: Patients with nonalcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) face a multifaceted disease burden which includes impaired health-related quality of life (HRQL) and potential stigmatization. We aimed to assess the burden of liver disease in patients with NAFLD and the relationship between experience of stigma and HRQL., Methods: Members of the Global NASH Council created a survey about disease burden in NAFLD. Participants completed a 35-item questionnaire to assess liver disease burden (LDB) (seven domains), the 36-item CLDQ-NASH (six domains) survey to assess HRQL and reported their experience with stigmatization and discrimination., Results: A total of 2,117 patients with NAFLD from 24 countries completed the LDB survey (48% Middle East and North Africa, 18% Europe, 16% USA, 18% Asia) and 778 competed CLDQ-NASH. Of the study group, 9% reported stigma due to NAFLD and 26% due to obesity. Participants who reported stigmatization due to NAFLD had substantially lower CLDQ-NASH scores (all p <0.0001). In multivariate analyses, experience with stigmatization or discrimination due to NAFLD was the strongest independent predictor of lower HRQL scores (beta from -5% to -8% of score range size, p < 0.02). Experience with stigmatization due to obesity was associated with lower Activity, Emotional Health, Fatigue, and Worry domain scores, and being uncomfortable with the term "fatty liver disease" with lower Emotional Health scores (all p < 0.05). In addition to stigma, the greatest disease burden as assessed by LDB was related to patients' self-blame for their liver disease., Conclusions: Stigmatization of patients with NAFLD, whether it is caused by obesity or NAFLD, is strongly and independently associated with a substantial impairment of their HRQL. Self-blame is an important part of disease burden among patients with NAFLD., Impact and Implications: Patients with nonalcoholic fatty liver disease (NAFLD), recently renamed metabolic dysfunction-associated steatotic liver disease (MASLD), may experience impaired health-related quality of life and stigmatization. Using a specifically designed survey, we found that stigmatization of patients with NAFLD, whether it is caused by obesity or the liver disease per se , is strongly and independently associated with a substantial impairment of their quality of life. Physicians treating patients with NAFLD should be aware of the profound implications of stigma, the high prevalence of self-blame in the context of this disease burden, and that providers' perception may not adequately reflect patients' perspective and experience with the disease., Competing Interests: ZMY: research funding or consultation fees from AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Cymabay, GlaxoSmithKline, Intercept, Novo Nordisk, Siemens, Madrigal, Merck; YY: consulting/advisory board for Novo Nordisk, Cymabay, and Zydus. VWSW: served as a consultant or advisory board member for AbbVie, Boehringer Ingelheim, Echosens, Gilead Sciences, Intercept, Inventiva, Novo Nordisk, Pfizer, Sagimet Biosciences, TARGET PharmaSolutions, Visirna, speaker for Abbott, AbbVie, Gilead Sciences, Novo Nordisk, Unilab, received a research grant from Gilead Sciences, co-founder of Illuminatio Medical Technology Limited; AMA: grant funding from NIH, Novo Nordisk, Target Pharma, consulting/advisory board for Novo Nordisk. JMS: consultant for Astra Zeneca, Apollo Endosurgery, Bayer, Boehringer Ingelheim, BMS, Gilead Sciences, GSK, Intercept Pharmaceuticals, Ipsen, Inventiva Pharma, Madrigal, MSD, Northsea Therapeutics, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Siemens Healthineers, receives research funding from Gilead Sciences, Boehringer Ingelheim, Siemens Healthcare GmbH, has stock options of AGED diagnostics, Hepta Bio, received speaker honorarium from Boehringer Ingelheim, Echosens, MedPublico GmbH, Novo Nordisk, Madrigal Pharmaceuticals, Histoindex, MedPublico GmbH. CWS: speaker bureau fees from Gilead Sciences, Abbott; RL: receives funding support from NCATS, NIDDK, NHLBI, serves as a consultant to Aardvark Therapeutics, Altimmune, Amgen, Arrowhead Pharmaceuticals, AstraZeneca, Eli Lilly, Gilead, Glympse bio, Inipharma, Intercept, Inventiva, Ionis, Janssen Inc., Madrigal, Novo Nordisk, Merck, Pfizer, Sagimet, Theratechnologies, 89 bio, Takeda, Terns Pharmaceuticals and Viking Therapeutics. In addition, his institution received research grants from Arrowhead Pharmaceuticals, Astrazeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Galectin Therapeutics, Gilead, Intercept, Hanmi, Intercept, Inventiva, Ionis, Janssen, Madrigal Pharmaceuticals, Merck, Novo Nordisk, Pfizer, Sonic Incytes, Terns Pharmaceuticals, co-founder of LipoNexus Inc. PC: received research grants by MSD and Intercept. JVL reports grants from AbbVie, MSD, Gilead Sciences and Roche Diagnostics to his institution and speaker fees from Echosens, Gilead Sciences, and Novo Nordisk. SF: holds a senior clinical investigator fellowship from the Research Foundation Flanders (FWO) (1802154N). His institution has received grants from Astellas, Falk Pharma, Genfit, Gilead Sciences, GlympsBio, Janssens Pharmaceutica, Inventiva, Merck Sharp & Dome, Pfizer, Roche. He has acted as consultant for Abbvie, Actelion, Aelin Therapeutics, AgomAb, Aligos Therapeutics, Allergan, Alnylam, Astellas, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristoll-Meyers Squibb, CSL Behring, Coherus, Echosens, Dr. Falk Pharma, Eisai, Enyo, Galapagos, Galmed, Genetech, Genfit, Genflow Biosciences, Gilead Sciences, Intercept, Inventiva, Janssens Pharmaceutica, PRO.MED.CS Praha, Julius Clinical, Madrigal, Medimmune, Merck Sharp & Dome, Mursla Bio, NGM Bio, Novartis, Novo Nordisk, Promethera, Roche, Siemens Healthineers. SF has been lecturer for Abbvie, Allergan, Bayer, Eisai, Genfit, Gilead Sciences, Janssens Cilag, Intercept, Inventiva, Merck Sharp & Dome, Novo Nordisk, Promethera, Siemens. AKS: Reports personal fees from Medscape Gastroenterology, Chronic Liver Disease Foundation, Medical Speakers Network, Up-to-Date; non-financial support from American Association for Study of Liver Diseases (AASLD), American College of Gastroenterology, and American Porphyria Foundation; grants from American College of Gastroenterology and National Institute of Health (NIAAA and NIDDK). Dr. Singal is a consultant on the SBIR grant for Pleiogenix pharmaceuticals and is DSMB member for phase 2-b trial of DUR-928 in alcoholic hepatitis for Durect Pharmaceuticals. In addition, apart from a steering committee member of the portal hypertension SIG and chair of the alcohol-associated liver disease SIG (2020-2022) of the AASLD, Dr. Singal currently is vice chair of the liver and biliary section of the AGA Council. None of these disclosures conflict with this activity. LC reports lecture fees from Echosens, Gilead, Inventiva and Novo Nordisk, consultancy fees from Echosens, Novo Nordisk, Madrigal, MSD, Pfizer, Sagimet, and Siemens. NA: Grant/research support from 89Bio, AbbVie/Allergan, Akero, Better Therapeutics, Boehringer Ingelheim, Bristol-Myers Squibb, Corcept, DSM, Galectin, Genentech, Genfit, Gilead, Hepagene, Healio, Intercept, Inventiva, Ionis, Madrigal, Merck, NGM, Noom, NorthSea, Novo Nordisk, Perspectum, Pfizer, Poxel, Viking, and Zydus; speaker’s fees from AbbVie/Allergan, Alexion, Echosens, Eisai, Exelixis, Gilead, Intercept, Perspectum, Salix, and Theratechnologies; Consultant for AbbVie/Allergan, Echosens, Fibronostics, Gilead, Intercept, Madrigal, Novo Nordisk, Perspectum, Pfizer, and Zydus. MEK: investigator/speaker/advisory board member: AstraZeneca, Roche, MSD, AbbVie, Eva, Mash Premier, Takeda, Organon, AUG, Inspire, HSO, Gilead, Janssen, Intercept, Rameda, Ipsen, Onxeo, MinaPharm, Pharco, Zeta, Alfa Cure, Bayer, Oncoustics, PDC, and Spimaco. JMS: Consultant - Astra Zeneca, Apollo Endosurgery, Bayer, Boehringer Ingelheim, Gilead Sciences, GSK, Intercept Pharmaceuticals, Ipsen, Inventiva Pharma, Madrigal, MSD, Northsea Therapeutics, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Siemens Healthineers. Research Funding: Gilead Sciences, Boehringer Ingelheim, Siemens Healthcare GmbH. Stock Options: AGED diagnostics, Hepta Bio. Speaker Honorarium: Boehringer Ingelheim, Echosens, MedPublico GmbH, Novo Nordisk, Madrigal Pharmaceuticals, Histoindex, MedPublico GmbH. MK: Research grants: Madrigal + consulting and speaking, Akero, Cymabay, Inventiva, Intercept + consulting and speaking.Gilead + consulting and speaking, Viking, Bio89, Ipsen + consulting, Genfit, Bausch + consulting, Ionis, North Sea,Celgene,Genentech, High Tide, Tobira-Allergan, Abbvie + consulting and speaking, NOT research. MLY: Research support (grant) from Abbvie, BMS, Gilead, Merck and Roche diagnostics; Consultant of Abbvie, BMS, Gilead, Roche and Roche diagnostics; Speaker of Abbvie, BMS, Eisai, Gilead, Roche and Roche diagnostics. S.Z-S has given a onetime presentation for and received support for attending meetings and/or travel from AbbVie, and a onetime consultation for Siemens, outside of the submitted work. PNN discloses the following financial relationship(s) on behalf of the University of Birmingham with a commercial interest: Grant/research support from Boehringer Ingelheim and Novo Nordisk; Consulting fees from Astra Zeneca, Boehringer Ingelheim, BMS, Gilead, GSK, Intercept, Madrigal, Novo Nordisk, Pfizer, Poxel Pharmaceuticals and Sun Pharma. Other coauthors report no conflicts of interest related to this study. Please refer to the accompanying ICMJE disclosure forms for further details., (© 2024 The Authors.)

Published
2024
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6. Global survey of stigma among physicians and patients with nonalcoholic fatty liver disease.

Author

Younossi ZM, Alqahtani SA, Alswat K, Yilmaz Y, Keklikkiran C, Funuyet-Salas J, Romero-Gómez M, Fan JG, Zheng MH, El-Kassas M, Castera L, Liu CJ, Wai-Sun Wong V, Zelber-Sagi S, Allen AM, Lam B, Treeprasertsuk S, Hameed S, Takahashi H, Kawaguchi T, Schattenberg JM, Duseja A, Newsome PN, Francque S, Spearman CW, Castellanos Fernández MI, Burra P, Roberts SK, Chan WK, Arrese M, Silva M, Rinella M, Singal AK, Gordon S, Fuchs M, Alkhouri N, Cusi K, Loomba R, Ranagan J, Eskridge W, Kautz A, Ong JP, Kugelmas M, Eguchi Y, Diago M, Yu ML, Gerber L, Fornaresio L, Nader F, Henry L, Racila A, Golabi P, Stepanova M, Carrieri P, and Lazarus JV

Subjects
Humans, Cross-Sectional Studies, Comorbidity, Obesity metabolism, Non-alcoholic Fatty Liver Disease complications, Metabolic Diseases complications, Gastroenterologists
Abstract

Background & Aims: Patients with fatty liver disease may experience stigma from the disease or comorbidities. In this cross-sectional study, we aimed to understand stigma among patients with nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) and healthcare providers., Methods: Members of the Global NASH Council created two surveys about experiences/attitudes toward NAFLD and related diagnostic terms: a 68-item patient and a 41-item provider survey., Results: Surveys were completed by 1,976 patients with NAFLD across 23 countries (51% Middle East/North Africa [MENA], 19% Europe, 17% USA, 8% Southeast Asia, 5% South Asia) and 825 healthcare providers (67% gastroenterologists/hepatologists) across 25 countries (39% MENA, 28% Southeast Asia, 22% USA, 6% South Asia, 3% Europe). Of all patients, 48% ever disclosed having NAFLD/NASH to family/friends; the most commonly used term was "fatty liver" (88% at least sometimes); "metabolic disease" or "MAFLD" were rarely used (never by >84%). Regarding various perceptions of diagnostic terms by patients, there were no substantial differences between "NAFLD", "fatty liver disease (FLD)", "NASH", or "MAFLD". The most popular response was being neither comfortable nor uncomfortable with either term (56%-71%), with slightly greater discomfort with "FLD" among the US and South Asian patients (47-52% uncomfortable). Although 26% of patients reported stigma related to overweight/obesity, only 8% reported a history of stigmatization or discrimination due to NAFLD. Among providers, 38% believed that the term "fatty" was stigmatizing, while 34% believed that "nonalcoholic" was stigmatizing, more commonly in MENA (43%); 42% providers (gastroenterologists/hepatologists 45% vs. 37% other specialties, p = 0.03) believed that the name change to metabolic dysfunction-associated steatotic liver disease (or MASLD) might reduce stigma. Regarding the new nomenclature, the percentage of providers reporting "steatotic liver disease" as stigmatizing was low (14%)., Conclusions: The perception of NAFLD stigma varies among patients, providers, geographic locations and sub-specialties., Impact and Implications: Over the past decades, efforts have been made to change the nomenclature of nonalcoholic fatty liver disease (NAFLD) to better align with its underlying pathogenetic pathways and remove any potential stigma associated with the name. Given the paucity of data related to stigma in NAFLD, we undertook this global comprehensive survey to assess stigma in NAFLD among patients and providers from around the world. We found there is a disconnect between physicians and patients related to stigma and related nomenclature. With this knowledge, educational programs can be developed to better target stigma in NAFLD among all stakeholders and to provide a better opportunity for the new nomenclature to address the issues of stigma., Competing Interests: Conflict of interest ZMY: research funding or consultation fees from AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Cymabay, GlaxoSmithKline, Intercept, Novo Nordisk, Siemens, Madrigal, Merck; VWSW: served as a consultant or advisory board member for AbbVie, Boehringer Ingelheim, Echosens, Gilead Sciences, Intercept, Inventiva, Novo Nordisk, Pfizer, Sagimet Biosciences, TARGET PharmaSolutions, Visirna, speaker for Abbott, AbbVie, Gilead Sciences, Novo Nordisk, Unilab, received a research grant from Gilead Sciences, co-founder of Illuminatio Medical Technology Limited; AMA: grant funding from NIH, Novo Nordisk, Target Pharma, consulting/advisory board for Novo Nordisk; JMS: consultant for Astra Zeneca, Apollo Endosurgery, Bayer, Boehringer Ingelheim, BMS, Gilead Sciences, GSK, Intercept Pharmaceuticals, Ipsen, Inventiva Pharma, Madrigal, MSD, Northsea Therapeutics, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Siemens Healthineers, receives research funding from Gilead Sciences, Boehringer Ingelheim, Siemens Healthcare GmbH, has stock options of AGED diagnostics, Hepta Bio, received speaker honorarium from Boehringer Ingelheim, Echosens, MedPublico GmbH, Novo Nordisk, Madrigal Pharmaceuticals, Histoindex, MedPublico GmbH; CWS: speaker bureau fees from Gilead Sciences, Abbott; RL: receives funding support from NCATS, NIDDK, NHLBI, serves as a consultant to Aardvark Therapeutics, Altimmune, Amgen, Arrowhead Pharmaceuticals, AstraZeneca, Eli Lilly, Gilead, Glympse bio, Inipharma, Intercept, Inventiva, Ionis, Janssen Inc., Madrigal, Novo Nordisk, Merck, Pfizer, Sagimet, Theratechnologies, 89 bio, Takeda, Terns Pharmaceuticals and Viking Therapeutics. In addition, his institution received research grants from Arrowhead Pharmaceuticals, Astrazeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Galectin Therapeutics, Gilead, Intercept, Hanmi, Intercept, Inventiva, Ionis, Janssen, Madrigal Pharmaceuticals, Merck, Novo Nordisk, Pfizer, Sonic Incytes, Terns Pharmaceuticals, co-founder of LipoNexus Inc; PC: received research grants by MSD and Intercept. Other coauthors report no conflicts of interest related to this study. Please refer to the accompanying ICMJE disclosure forms for further details., (Copyright © 2023 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Published
2024
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7. A multisociety Delphi consensus statement on new fatty liver disease nomenclature.

Author

Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, Romero D, Abdelmalek MF, Anstee QM, Arab JP, Arrese M, Bataller R, Beuers U, Boursier J, Bugianesi E, Byrne CD, Narro GEC, Chowdhury A, Cortez-Pinto H, Cryer DR, Cusi K, El-Kassas M, Klein S, Eskridge W, Fan J, Gawrieh S, Guy CD, Harrison SA, Kim SU, Koot BG, Korenjak M, Kowdley KV, Lacaille F, Loomba R, Mitchell-Thain R, Morgan TR, Powell EE, Roden M, Romero-Gómez M, Silva M, Singh SP, Sookoian SC, Spearman CW, Tiniakos D, Valenti L, Vos MB, Wong VW, Xanthakos S, Yilmaz Y, Younossi Z, Hobbs A, Villota-Rivas M, and Newsome PN

Subjects
Female, Male, Humans, Delphi Technique, Ethanol, Cardiometabolic Risk Factors, Consensus, Hepatomegaly, Non-alcoholic Fatty Liver Disease diagnosis, Non-alcoholic Fatty Liver Disease epidemiology
Abstract

The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favor of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. A total of 236 panelists from 56 countries participated in 4 online surveys and 2 hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83%, and 78%, respectively. Seventy-four percent of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms "nonalcoholic" and "fatty" were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease was chosen as an overarching term to encompass the various aetiologies of steatosis. The term steatohepatitis was felt to be an important pathophysiological concept that should be retained. The name chosen to replace NAFLD was metabolic dysfunction-associated steatotic liver disease. There was consensus to change the definition to include the presence of at least 1 of 5 cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic steatotic liver disease. A new category, outside pure metabolic dysfunction-associated steatotic liver disease, termed metabolic and alcohol related/associated liver disease (MetALD), was selected to describe those with metabolic dysfunction-associated steatotic liver disease, who consume greater amounts of alcohol per week (140-350 g/wk and 210-420 g/wk for females and males, respectively). The new nomenclature and diagnostic criteria are widely supported and nonstigmatising, and can improve awareness and patient identification., Competing Interests: Declaration of interests Manal F. Abdelmalek consults, advises, and received grants from Bristol Myers Squibb, Hanmi, Intercept, Inventiva, and Madrigal. She consults and advises 89Bio, Merck, NGM Bio, Novo Nordisk, Sonic Incytes, and Theratechnologies. She is on the speakers’ bureau for the Chronic Liver Disease Foundation, Clinical Care Options, Fishawack, Medscape, and Terra Firma. She received grants from Allergan, Boehringer Ingelheim, Celgene, Durect, Enanta, Enyo, Galmed, Genentech, Gilead, Novo Nordisk, Poxel, Target NASH, and Viking. Quentin M. Anstee, on behalf of Newcastle University, consults for Alimentiv, Akero, AstraZeneca, Axcella, 89Bio, Boehringer Ingelheim, Bristol Myers Squibb, Galmed, GENFIT, Genentech, Gilead, GSK, Hanmi, HistoIndex, Intercept, Inventiva, Ionis, IQVIA, Janssen, Madrigal, Medpace, Merck, NGM Bio, Novartis, Novo Nordisk, PathAI, Pfizer, Pharmanest, Prosciento, Poxel, RTI, Resolution Therapeutics, Ridgeline Therapeutics, Roche, Shionogi, and Terns. He is on the speakers’ bureau for Fishawack, Integritas Communications, Kenes, Novo Nordisk, Madrigal, Medscape, and Springer Healthcare. He received grants from AstraZeneca, Boehringer Ingelheim, and Intercept. He holds intellectual property rights with Elsevier, Ltd. Ramon Bataller is on the speakers’ bureau for Abbvie and Gilead. Ulrich Beuers consults for CSL Behring. He is on the speakers’ bureau for Abacus and Zambon. Elisabetta Bugianesi advises Boehringer Ingelheim, MSD, and Novo Nordisk. Helena Cortez-Pinto consults and received grants from Novo Nordisk and Roche. She received grants from Eisai, Gilead, GMP-Orphan, and Intercept. Kenneth Cusi Consults for Aligos, Arrowhead, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Covance, Lilly, Madrigal, Myovant, Novo Nordisk, Prosciento, Sagimet, and Siemens. He received grants from Echosens, Inventiva, LabCorp, Nordic Biosciences, and Target NASH. Sven M. Francque consults and received grants from Astellas, Falk, GENFIT, Gilead, Glympse Bio, Janssen, Inventiva, Merck, Pfizer, and Roche. He consults for AbbVie., Actelion, Aelin Therapeutics, Allergan, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Coherus, CSL Behring, Echosens, Eisai, ENYO, Galapagos, Galmed, Genetech, Intercept, Julius Clinical, Madrigal, Medimmune, NGM Bio, Novartis, Novo Nordisk, and Promethera. Samer Gawrieh consults for Pfizer and TransMedics. He received grants from LiverIncytes, Viking, and Zydus. Manuel Romero-Gómez advises and received grants from Novo Nordisk and Siemens. He advises AbbVie., Alpha-sigma, Allergan, AstraZeneca, Axcella, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Intercept, Inventia, Kaleido, MSD, Pfizer, Prosciento, Rubió, Shionogi, Sobi, and Zydus. He received grants from Echosens and Theratechnologies. Cynthia D. Guy consults for 89Bio, CymaBay, HistoIndex, Madrigal, and NGM. Stephen Harrison consults, advises, is involved with trials, received grants, and owns stock in Akero, Galectin, GENFIT, Hepion, and NGM Bio. He consults, advises, is involved with trials, and received grants from Axcella, Gilead, Intercept, Madrigal, and Poxel. He consults, advises, received grants, and owns stock in NorthSea Therapeutics. He consults, advises, and is involved with trials for Terns. He consults, advises, and received grants from HighTide, Novartis, Novo Nordisk, and Sagimet. He consults, advises, and owns stock in HistoIndex, Metacrine, and Sonic Incytes. He consults, received grants, and owns stock in Cirius. He consults, is involved with trials, and received grants from ENYO and Viking. He is involved with trials and received grants from Genentech. He consults and is involved with trials for Ionis. He consults and received grants from CiVi, CymaBay, Galmed, and Pfizer. He consults and owns stock in Hepta Bio. He consults and advises for Altimmune, Echosens North America, Foresite Labs, and Medpace. He advises and owns stock in ChronWell. He consults for AgomAb, Alentis, Aligos Therapeutics, Alimentiv, Blade, Bluejay, Boston Pharmaceuticals, Boxer Capital, CanFite BioPharma, the Chronic Liver Disease Foundation (CLDF), CohBar, Corcept, Fibronostics, Fortress Biotech, Galecto, Gelesis, GSK, GNS Healthcare, GRI Bio, Hepagene, Indalo, Inipharm, Innovate Biopharmaceuticals, Kowa Research Institute, Merck, MGGM, NeuroBo, Nutrasource, Perspectum, Piper Sandler, Prometic (now Liminal BioSciences), Ridgeline Therapeutics, Silverback, and Zafgen (now Larimar). He advises Arrowhead BVF Partners, Humana, and Pathai. He received grants from Bristol Myers Squibb, Conatus, Immuron, and Second Genome. Samuel Klein advises Alnylam, Altimmune, and Merck. Kris V. Kowdley advises, is on the speakers’ bureau, and received grants from Gilead and Intercept. He advises, received grants, and owns stock in Inipharm. He advises and received grants from 89bio, CymaBay, GENFIT, Ipsen, Madrigal, Mirum, NGM Bio, Pfizer, Pliant, and Zeds. He advises Enact, HighTide, and Protagonist. He is on the speakers’ bureau for AbbVie. He received grants from Boston Pharmaceuticals, Corcept, GSK, Hanmi, Janssen, Novo Nordisk, Terns, and Viking. Jeffrey V. Lazarus consults for Novavax. He received grants from AbbVie, Gilead, MSD, and Roche Diagnostics. Rohit Loomba consults and received grants from Arrowhead, AstraZeneca, Bristol Myers Squibb, Galmed, Gilead, Intercept, Inventiva, Ionis, Janssen, Lilly, Madrigal, Merck, NGM Bio, Novo Nordisk, Pfizer, and Terns. He consults and owns stock in 89Bio and Sagimet. Consults for Altimmune, Anylam, Amgen, CohBar, Glympse Bio, HighTide, Inipharm, Metacrine, Novartis, Regeneron, Theratechnologies, and Viking. He received grants from Boehringer Ingelheim, Galectin Therapeutics, Hanmi, and Sonic Incytes. He cofounded and owns stock in LipoNexus. Phillip N. Newsome consults, advises, is on the speakers’ bureau, and received grants from Novo Nordisk. He consults and advises Boehringer Ingelheim, Bristol Myers Squibb, Gilead, GSK, Intercept, Madrigal, Pfizer, Poxel, and Sun Pharma. He is on the speakers’ bureau for AiCME. Elizabeth E. Powell advises and received grants from Novo Nordisk. Vlad Ratziu consults and received grants from Intercept. He consults for Boehringer Ingelheim, Eny, Madrigal, NorthSea, Novo Nordisk, E. Poxel, and Sagimet. He received grants from Gilead. Mary E. Rinella consults for Boehringer Ingelheim, CytoDyn, GSK, Novo Nordisk, HistoIndex, Intercept, Madrigal, NGM Bio, and Sonic Incytes. Michael Roden consults and received grants from Boehringer Ingelheim and Novo Nordisk. He consults for Lilly. He is on the speakers’ bureau for AstraZeneca. Arun J. Sanyal consults and advises Avant Santé and AstraZeneca. He consults and received grants from Akero, Bristol Myers Squibb, Intercept, Lilly, Madrigal, and Novo Nordisk. He consults and owns stock in Rivus. He consults for AGED Diagnostics, Albireo, Alnylam, Altimmune, Boehringer Ingelhiem, 89Bio, Echosense, Genentech, Gilead, GSK, HistoIndex, Malinckrodt, Merck, NGM Bio, Novartis, PathAI, Pfizer, Poxel, Regeneron, Salix, Siemens, Surrozen, Takeda, Terns, and Zydus. He owns stock in Durect, Exhalenz, GENFIT, Indalo, Inversago, and Tiziana. He received royalties from Elsevier and Wolters Kluwer. Marcelo Silva consults, advises, and received grants from Zydus. He received grants from Inventiva and MSD. Dina Tiniakos consults for Clinnovate Health, ICON, Ionis, Inventiva, Merck, and Verily. Luca Valenti consults and received grants from Gilead. He consults for AstraZeneca, Boehringer Ingelheim, MSD, Novo Nordisk, Pfizer, and Resalis Therapeutics. Miriam B. Vos consults and advises Thiogenesis. She consults and received grants from Target Real World Evidence. She consults and owns stock in Intercept. She consults for Albireo, Boehringer Ingelheim, Lilly, Novo Nordisk, and Takeda. She received grants from Bristol Myers Squibb, Quest, and Sonic Incytes. Vincent Wai-Sun Wong consults and received grants from Gilead. He consults for AbbVie, Boehringer Ingelheim, Echosens, Intercept, Inventiva, Novo Nordisk, Pfizer, Sagimet, and TARGET PharmaSolutions. He owns stock in Illuminatio Medical Technology. Yusuf Yilmaz consults for Zydus. He advises Novo Nordisk. He is on the speakers’ bureau for Echosens. Zobair Younossi consults for Bristol Myers Squibb, Gilead, Intercept, Madrigal, Merck, Novartis, Novo Nordisk, Quest, Siemens, and Terns. The remaining authors have no conflicts to report., (Copyright © 2023 Mary E. Rinella, Jeffrey V. Lazarus, Vlad Ratziu, Sven M. Francque, Arun J. Sanyal, Fasiha Kanwal, Diana Romero, Manal F. Abdelmalek, Quentin M. Anstee, Juan Pablo Arab, Marco Arrese, Ramon Bataller, Ulrich Beuers, Jerome Boursier, Elisabetta Bugianesi, Christopher D. Byrne, Graciela E. Castro Narro, Abhijit Chowdhury, Helena Cortez-Pinto, Donna Cryer, Kenneth Cusi, Mohamed El-Kassas, Samuel Klein, Wayne Eskridge, Jiangao Fan, Samer Gawrieh, Cynthia D. Guy, Stephen A. Harrison, Seung Up Kim, Bart Koot, Marko Korenjak, Kris Kowdley, Florence Lacaille, Rohit Loomba, Robert Mitchell-Thain, Timothy R. Morgan, Elisabeth Powell, Michael Roden, Manuel Romero-Gómez, Marcelo Silva, Shivaram Prasad Singh, Silvia C. Sookoian, C. Wendy Spearman, Dina Tiniakos, Luca Valenti, Miriam B. Vos, Vincent Wai-Sun Wong, Stavra Xanthakos, Yusuf Yilmaz, Zobair Younossi, Ansley Hobbs, Marcela Villota-Rivas, Philip N. Newsome (senior), NAFLD Nomenclature consensus group. Published by Elsevier España, S.L.U. All rights reserved.)

Published
2024
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8. A multisociety Delphi consensus statement on new fatty liver disease nomenclature.

Author

Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, Romero D, Abdelmalek MF, Anstee QM, Arab JP, Arrese M, Bataller R, Beuers U, Boursier J, Bugianesi E, Byrne CD, Castro Narro GE, Chowdhury A, Cortez-Pinto H, Cryer DR, Cusi K, El-Kassas M, Klein S, Eskridge W, Fan J, Gawrieh S, Guy CD, Harrison SA, Kim SU, Koot BG, Korenjak M, Kowdley KV, Lacaille F, Loomba R, Mitchell-Thain R, Morgan TR, Powell EE, Roden M, Romero-Gómez M, Silva M, Singh SP, Sookoian SC, Spearman CW, Tiniakos D, Valenti L, Vos MB, Wong VW, Xanthakos S, Yilmaz Y, Younossi Z, Hobbs A, Villota-Rivas M, and Newsome PN

Subjects
Female, Male, Humans, Delphi Technique, Ethanol, Consensus, Hepatomegaly, Non-alcoholic Fatty Liver Disease diagnosis
Abstract

The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favour of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. A total of 236 panellists from 56 countries participated in 4 online surveys and 2 hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83%, and 78%, respectively. Seventy-four percent of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms "nonalcoholic" and "fatty" were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease was chosen as an overarching term to encompass the various aetiologies of steatosis. The term steatohepatitis was felt to be an important pathophysiological concept that should be retained. The name chosen to replace NAFLD was metabolic dysfunction-associated steatotic liver disease (MASLD). There was consensus to change the definition to include the presence of at least 1 of 5 cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic steatotic liver disease. A new category, outside pure metabolic dysfunction-associated steatotic liver disease, termed metabolic and alcohol related/associated liver disease (MetALD), was selected to describe those with metabolic dysfunction-associated steatotic liver disease, who consume greater amounts of alcohol per week (140-350 g/wk and 210-420 g/wk for females and males, respectively). The new nomenclature and diagnostic criteria are widely supported and non-stigmatising, and can improve awareness and patient identification., (Copyright © 2023 Mary E. Rinella, Jeffrey V. Lazarus, Vlad Ratziu, Sven M. Francque, Arun J. Sanyal, Fasiha Kanwal, Diana Romero, Manal F. Abdelmalek, Quentin M. Anstee, Juan Pablo Arab, Marco Arrese, Ramon Bataller, Ulrich Beuers, Jerome Boursier, Elisabetta Bugianesi, Christopher Byrne, Graciela E. Castro Narro, Abhijit Chowdhury, Helena Cortez-Pinto, Donna Cryer, Kenneth Cusi, Mohamed El-Kassas, Samuel Klein, Wayne Eskridge, Jiangao Fan, Samer Gawrieh, Cynthia D. Guy, Stephen A. Harrison, Seung Up Kim, Bart Koot, Marko Korenjak, Kris Kowdley, Florence Lacaille, Rohit Loomba, Robert Mitchell-Thain, Timothy R. Morgan, Elisabeth Powell, Michael Roden, Manuel Romero-Gómez, Marcelo Silva, Shivaram Prasad Singh, Silvia C. Sookoian, C. Wendy Spearman, Dina Tiniakos, Luca Valenti, Miriam B. Vos, Vincent Wai-Sun Wong, Stavra Xanthakos, Yusuf Yilmaz, Zobair Younossi, Ansley Hobbs, Marcela Villota-Rivas, Philip N. Newsome, NAFLD Nomenclature consensus group. Published by Elsevier B.V. All rights reserved.)

Published
2023
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9. Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis: The Patient and Physician Perspective.

Author

Eskridge W, Cryer DR, Schattenberg JM, Gastaldelli A, Malhi H, Allen AM, Noureddin M, and Sanyal AJ

Abstract

Diagnosing and managing metabolic dysfunction-associated steatotic liver disease (MASLD) remains a major challenge in primary care due to lack of agreement on diagnostic tools, difficulty in identifying symptoms and determining their cause, absence of approved pharmacological treatments, and limited awareness of the disease. However, prompt diagnosis and management are critical to preventing MASLD from progressing to more severe forms of liver disease. This highlights the need to raise awareness and improve understanding of MASLD among both patients and physicians. The patient perspective is invaluable to advancing our knowledge of this disease and how to manage it, as their perspectives have led to the growing recognition that patients experience subtle symptoms and that patient-reported outcomes should be incorporated into drug development. This review and expert opinion examine MASLD and metabolic dysfunction-associated steatohepatitis from the patient and physician perspective from pre-diagnosis to diagnosis and early care, through to progression to advanced liver damage. Specifically, the paper dives into the issues patients and physicians experience, and, in turn, what is required to improve diagnosis and management, including tips and tools to empower patients and physicians dealing with MASLD.

Published
2023
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10. Screening for undiagnosed non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH): A population-based risk factor assessment using vibration controlled transient elastography (VCTE).

Author

Eskridge W, Vierling JM, Gosbee W, Wan GA, Hyunh ML, and Chang HE

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Risk Factors, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease diagnostic imaging
Abstract

The screening for undiagnosed non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (SUNN) study was a population-based screening study that aimed to provide proof of concept to encourage community-level screening and detection for this non-communicable disease. Current screening guidelines do not recommend the routine screening of nonalcoholic fatty liver disease (NAFLD) for asymptomatic populations, so providers are not encouraged to actively seek disease, even in high-risk patients. This study sought to determine whether a self-selecting cohort of asymptomatic individuals would have scores based on vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP) significantly correlated to risk factors to suggest that routine screening for high-risk patients should be recommended. The study recruited 1,070 self-selected participants in Houston and Galveston County, Texas, 940 of which were included in final analysis. A pre-screening survey was used to determine eligibility. VCTE-based scores analyzed steatosis and fibrosis levels. Fifty-seven percent of the study population demonstrated steatosis without fibrosis, suggesting NAFLD, while 16% demonstrated both steatosis and fibrosis, suggesting NASH. Statistically significant risk factors included factors related to metabolic syndrome, race, and age, while statistically significant protective factors included consumption of certain foods and exercise. The findings of this study suggest that high-risk individuals should be screened for NAFLD even in the absence of symptoms and that community-based screenings are an effective tool, particularly in the absence of proactive guidelines for providers., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: WE, GAW, MLH, and HEC are employees of FLF, which reports program support and educational grants from Allergan, Amazon, Bristol-Myers Squibb, Celgene, Clinical Care Options, Continuum Clinical, Echosens, Eskridge Family Trust, Fibronostics, First Line Creative, Gilead Sciences, Global Engage, Google, Health Business Solutions, Intercept Pharmaceuticals, Madrigal Pharmaceuticals, Meetrix, Merck & Co., Inc. NetNoggin, Prosciento, Pfizer, Terns Pharmaceuticals and various private and philanthropic individual donors. JMV reports relevant research and grant support from Allergan, Alnylam, 89Bio, Bristol-Myers Squibb, Celgene, CymaBay, Exalenz, Galectin, Galmed, Genfit, Gilead, Hanmi, Immuron, Intercept, Madrigal, Merck, Mochida, Molecular Stethoscope, Novartis, NovoNordisk, Pliant, Sagimet, Tobira Therapeutics, and Zydus; advisor or consultant fees from Allergan, Blade Pharmaceuticals, Bristol-Myers Squibb, Conatus, CymaBay, Exalenz, Fractyl, Intercept, Novartis; and is on the Data Safety and Management Boards for NIH NIDDK Drug-Induced Liver Injury Network (DILIN) and Fractyl. WG reports grant support from AbbVie and Gilead Sciences. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Published
2021
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11. Redefining fatty liver disease: an international patient perspective.

Author

Shiha G, Korenjak M, Eskridge W, Casanovas T, Velez-Moller P, Högström S, Richardson B, Munoz C, Sigurðardóttir S, Coulibaly A, Milan M, Bautista F, Leung NWY, Mooney V, Obekpa S, Bech E, Polavarapu N, Hamed AE, Radiani T, Purwanto E, Bright B, Ali M, Dovia CK, McColaugh L, Koulla Y, Dufour JF, Soliman R, and Eslam M

Subjects
Global Health, Humans, Quality Improvement, Terminology as Topic, Metabolic Diseases, Non-alcoholic Fatty Liver Disease diagnosis, Non-alcoholic Fatty Liver Disease epidemiology, Non-alcoholic Fatty Liver Disease metabolism, Patient Care Management methods, Patient Care Management standards
Abstract

Despite its increased recognition as a major health threat, fatty liver disease associated with metabolic dysfunction remains largely underdiagnosed and undertreated. An international consensus panel has called for the disease to be renamed from non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD) and has suggested how the disease should be diagnosed. This Viewpoint explores the call from the perspective of patient advocacy groups. Patients are well aware of the negative consequences of the NAFLD acronym. This advocacy group enthusiastically endorses the call to reframe the disease, which we believe will ultimately have a positive effect on patient care and quality of life and, through this effect, will reduce the burden on health-care systems. For patients, policy makers, health planners, donors, and non-hepatologists, the new acronym MAFLD is clear, squarely placing the disease as a manifestation of metabolic dysfunction and improving understanding at a public health and patient level. The authors from representative patient groups are supportive of this change, particularly as the new acronym is meaningful to all citizens as well as governments and policy makers, and, above all, is devoid of any stigma., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Published
2021
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