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1. A global action agenda for turning the tide on fatty liver disease

Author

Lazarus, J, Mark, H, Allen, A, Arab, J, Carrieri, P, Noureddin, M, Alazawi, W, Alkhouri, N, Alqahtani, S, Anstee, Q, Arrese, M, Bataller, R, Berg, T, Brennan, P, Burra, P, Castro-Narro, G, Cortez-Pinto, H, Cusi, K, Dedes, N, Duseja, A, Francque, S, Gastaldelli, A, Hagström, H, Huang, T, Ivancovsky Wajcman, D, Kautz, A, Kopka, C, Krag, A, Newsome, P, Rinella, M, Romero, D, Sarin, S, Silva, M, Spearman, C, Terrault, N, Tsochatzis, E, Valenti, L, Villota-Rivas, M, Zelber-Sagi, S, Schattenberg, J, Wong, V, Younossi, Z, Perseghin, G, Lazarus, Jeffrey V, Mark, Henry E, Allen, Alina M, Arab, Juan Pablo, Carrieri, Patrizia, Noureddin, Mazen, Alazawi, William, Alkhouri, Naim, Alqahtani, Saleh A, Anstee, Quentin M, Arrese, Marco, Bataller, Ramon, Berg, Thomas, Brennan, Paul N, Burra, Patrizia, Castro-Narro, Graciela E, Cortez-Pinto, Helena, Cusi, Kenneth, Dedes, Nikos, Duseja, Ajay, Francque, Sven M, Gastaldelli, Amalia, Hagström, Hannes, Huang, Terry T K, Ivancovsky Wajcman, Dana, Kautz, Achim, Kopka, Christopher J, Krag, Aleksander, Newsome, Philip N, Rinella, Mary E, Romero, Diana, Sarin, Shiv Kumar, Silva, Marcelo, Spearman, C Wendy, Terrault, Norah A, Tsochatzis, Emmanuel A, Valenti, Luca, Villota-Rivas, Marcela, Zelber-Sagi, Shira, Schattenberg, Jörn M, Wong, Vincent Wai-Sun, Younossi, Zobair M, Perseghin, Gianluca, Lazarus, J, Mark, H, Allen, A, Arab, J, Carrieri, P, Noureddin, M, Alazawi, W, Alkhouri, N, Alqahtani, S, Anstee, Q, Arrese, M, Bataller, R, Berg, T, Brennan, P, Burra, P, Castro-Narro, G, Cortez-Pinto, H, Cusi, K, Dedes, N, Duseja, A, Francque, S, Gastaldelli, A, Hagström, H, Huang, T, Ivancovsky Wajcman, D, Kautz, A, Kopka, C, Krag, A, Newsome, P, Rinella, M, Romero, D, Sarin, S, Silva, M, Spearman, C, Terrault, N, Tsochatzis, E, Valenti, L, Villota-Rivas, M, Zelber-Sagi, S, Schattenberg, J, Wong, V, Younossi, Z, Perseghin, G, Lazarus, Jeffrey V, Mark, Henry E, Allen, Alina M, Arab, Juan Pablo, Carrieri, Patrizia, Noureddin, Mazen, Alazawi, William, Alkhouri, Naim, Alqahtani, Saleh A, Anstee, Quentin M, Arrese, Marco, Bataller, Ramon, Berg, Thomas, Brennan, Paul N, Burra, Patrizia, Castro-Narro, Graciela E, Cortez-Pinto, Helena, Cusi, Kenneth, Dedes, Nikos, Duseja, Ajay, Francque, Sven M, Gastaldelli, Amalia, Hagström, Hannes, Huang, Terry T K, Ivancovsky Wajcman, Dana, Kautz, Achim, Kopka, Christopher J, Krag, Aleksander, Newsome, Philip N, Rinella, Mary E, Romero, Diana, Sarin, Shiv Kumar, Silva, Marcelo, Spearman, C Wendy, Terrault, Norah A, Tsochatzis, Emmanuel A, Valenti, Luca, Villota-Rivas, Marcela, Zelber-Sagi, Shira, Schattenberg, Jörn M, Wong, Vincent Wai-Sun, Younossi, Zobair M, and Perseghin, Gianluca

Abstract

Background and Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach and Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over 2 rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities using Qualtrics XM, indicating agreement using a 4-point Likert-scale and providing written feedback. Priorities were revised between rounds, and in R2, panelists also ranked the priorities within 6 domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2, the mean percentage of “agree” responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% “agree”). The highest-ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance. Conclusions: This consensus-driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reduce fatty liver disease prevalence and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels.

Published
2024

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

Author

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

3. Eliminating hepatitis C on the Balearic Islands, Spain: a protocol for an intervention study to test and link people who use drugs to treatment and care

Author

Àngels Vilella, Juan Manuel Alonso, Antonella Perrotta, Albert Moratinos, Antonia Rodríguez, Francisca Bibiloni, Camila A. Picchio, Maria Buti, Andrea Herranz, Elisabet Tegeo, Jeffrey V. Lazarus, Marcela Villota-Rivas, Institut Català de la Salut, [Lazarus JV, Herranz A, Picchio CA, Villota-Rivas M] Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain. [Rodríguez A] Servicio médico, Centro Penitenciario de Mallorca, Palma de Mallorca, Spain. [Alonso JM] Unitat de Conductes Addictives 4 (IBSalut), Palma de Mallorca, Spain. [Buti M] Unitat del Fetge, Vall d’Hebron Hospital Universitari, Barcelona, Spain. CIBER-EHD, Instituto de Salud Carlos III, Madrid, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
medicine.medical_specialty, media_common.quotation_subject, Population, Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores], Prison, Hepacivirus, Disease, World Health Organization, Global Health, Other subheadings::Other subheadings::/drug therapy [Other subheadings], Antiviral Agents, Abús de substàncies - Illes Balears, Digestive System Diseases::Liver Diseases::Hepatitis::Hepatitis, Viral, Human::Hepatitis C [DISEASES], Hepatitis C - Tractament - Illes Balears, Health care, medicine, Humans, Medicaments antivírics, Substance Abuse, Intravenous, education, media_common, education.field_of_study, business.industry, Addiction, Public health, enfermedades del sistema digestivo::enfermedades hepáticas::hepatitis::hepatitis viral humana::hepatitis C [ENFERMEDADES], public health, Chemically-Induced Disorders::Substance-Related Disorders::Substance Abuse, Intravenous [DISEASES], General Medicine, Hepatitis C, medicine.disease, trastornos inducidos químicamente::trastornos relacionados con sustancias::abuso de sustancias por vía intravenosa [ENFERMEDADES], virology, Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antiviral Agents [CHEMICALS AND DRUGS], Pharmaceutical Preparations, Spain, hepatology, Family medicine, acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antivíricos [COMPUESTOS QUÍMICOS Y DROGAS], Medicine, business, Methadone, medicine.drug
Abstract

Hepatology; Public health; Virology Hepatología; Salud pública; Virología Hepatologia; Salut pública; Virologia Introduction The hepatitis C virus (HCV) is a highly infectious and deadly disease, affecting some 58 million people worldwide. Of the 1.13 million people living in the Balearic Islands, Spain, about 1350 individuals have untreated HCV. Of these, about 1120 (83%) are estimated to be people who use drugs (PWUD), who are one of the key at-risk groups for HCV infection globally. Carrying out micro-elimination approaches focused on this population is crucial to achieve the WHO goal of eliminating HCV by 2030. Thus, the primary objective of this study is to validate a model of care that simplifies the screening and linkage to HCV care pathways for PWUD on the Balearic Islands. Methods and analysis This intervention study will be implemented across 17 sites, in 4 different settings: addiction service centres (n=12), non-governmental organisation centres (n=3), a mobile methadone unit and a prison, with an estimated 3725 participants. Together with the healthcare staff at each centre, the intervention protocols will be adapted, focusing on four phases: recruitment and testing; linkage to care; treatment for those who test positive; and monitoring of sustained virological response 12 weeks after treatment and reinfection. The primary outcomes will be the number of tested and treated individuals and the secondary outcomes will include individuals lost at each step in the cascade of care. Descriptive analysis and multivariable logistic regression of the data will be undertaken. Ethics and dissemination The Hospital Clínic Barcelona, Spain, Ethics Committee approved this study on 18 February 2021 (HCB/2020/2018). Findings will be disseminated through peer-reviewed publications, conference presentations and social media. The results of this study could provide a model for targeting PWUD for HCV testing and treatment in the rest of Spain and in other settings, helping to achieve the WHO HCV elimination goal. This project is supported by Gilead Sciences, through the competitive research call HCV STAT.

Published
2021

4. A narrative review of lifestyle management guidelines for metabolic dysfunction-associated steatotic liver disease.

Author

Ivancovsky Wajcman D, Byrne CJ, Dillon JF, Brennan PN, Villota-Rivas M, Younossi ZM, Allen AM, Crespo J, Gerber LH, and Lazarus JV

Abstract

Background Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) management guidelines have been published worldwide; we aimed to summarize, categorize and compare their lifestyle intervention recommendations., Approach Results: We searched MASLD/nonalcoholic fatty liver disease (NAFLD) management guidelines published between 1 January 2013 and 31 June 2024 via databases including PubMed/MEDLINE, Cochrane, and CINAHL. In total, 35 qualifying guidelines were included in the final analysis. Guideline recommendations were categorized into five domains (i.e., weight reduction goals, physical activity, nutrition, alcohol, and tobacco smoking) and were ranked based on how frequently they appeared. A recommendation was defined as widely adopted if recommended in ≥24 (≥66.6%) of the guidelines. These included increase physical activity; reduce body weight by 7-10% to improve steatohepatitis and/or fibrosis; restrict caloric intake; undertake 150-300 or 75-150 minutes/week of moderate or vigorous-intensity physical activity, respectively; and decrease consumption of commercially produced fructose. The least mentioned topics, in ≤9 of the guidelines, evaluated environmental determinants of health, mental health, referring patients for psychological or cognitive behavioral therapy, using digital health interventions (DHIs), and assessing patients' social determinants of health., Conclusions: Most guidelines recommend weight reduction through physical activity and improving nutrition, as these have proven positive effects on health outcomes when sustained. However, gaps regarding mental health and the social and environmental determinants of MASLD were found. To optimize behavioral modifications and treatment, we recommend carrying out studies that will provide further evidence on social support, environmental factors, and mental health, and further exploring DHIs., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Published
2024
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5. The burden of liver disease in Latin America.

Author

Díaz LA, Villota-Rivas M, Barrera F, Lazarus JV, and Arrese M

Subjects
Humans, Latin America epidemiology, Risk Factors, Prevalence, Alcohol Drinking epidemiology, Alcohol Drinking adverse effects, Health Policy, Liver Transplantation, Cost of Illness, Liver Diseases epidemiology
Abstract

Liver disease poses a substantial burden in Latin America. This burden is primarily attributed to a high level of alcohol consumption and the increasing prevalence of risk factors associated with metabolic dysfunction-associated steatotic liver disease (MASLD), such as sedentary lifestyles, easy access to ultra-processed foods, obesity, and type 2 diabetes mellitus. These epidemiological trends are cause for concern, especially considering that there are significant challenges in addressing them due to disparities in access to liver disease screening and care. In this article, we aim to provide an overview of the current situation regarding liver disease in Latin America. We also discuss recent multinational proposals designed to address the growing MASLD burden via its integration into existing non-communicable diseases policies, at both local and global levels. Additionally, we emphasize the urgent need to establish effective public health policies that target both MASLD risk factors and excessive alcohol consumption. Furthermore, we discuss the development of liver transplantation programs, areas for improvement in medical education and research capabilities, and how the fostering of extensive collaboration among all stakeholders is crucial for addressing liver disease in the region., Competing Interests: Conflicts of interest J.V.L. acknowledges grants and speaker fees from AbbVie, Gilead Sciences, MSD, and Roche Diagnostics to his institution, speaker fees from Echosens, Janssen, Novo Nordisk, and ViiV, and consulting fees from GSK and Novavax, outside of the submitted work. L.A.D., M.V.-R., F.B., and M.A. declare no conflicts of interest., (Copyright © 2023 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.)

Published
2024
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6. The future of International Classification of Diseases coding in steatotic liver disease: An expert panel Delphi consensus statement.

Author

Hagström H, Adams LA, Allen AM, Byrne CD, Chang Y, Duseja A, Grønbæk H, Ismail MH, Jepsen P, Kanwal F, Kramer J, Loomba R, Mark HE, Newsome PN, Rinella ME, Rowe IA, Ryu S, Sanyal A, Schattenberg JM, Serper M, Sheron N, Simon TG, Spearman CW, Tapper EB, Villota-Rivas M, Wild SH, Wong VW, Yilmaz Y, Zelber-Sagi S, Åberg F, and Lazarus JV

Subjects
Humans, Delphi Technique, Consensus, International Classification of Diseases, Liver Diseases
Abstract

Background: Following the adoption of new nomenclature for steatotic liver disease, we aimed to build consensus on the use of International Classification of Diseases codes and recommendations for future research and advocacy., Methods: Through a two-stage Delphi process, a core group (n = 20) reviewed draft statements and recommendations (n = 6), indicating levels of agreement. Following revisions, this process was repeated with a large expert panel (n = 243) from 73 countries., Results: Consensus ranged from 88.8% to 96.9% (mean = 92.3%)., Conclusions: This global consensus statement provides guidance on harmonizing the International Classification of Diseases coding for steatotic liver disease and future directions to advance the field., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.)

Published
2024
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7. A global action agenda for turning the tide on fatty liver disease.

Author

Lazarus JV, Mark HE, Allen AM, Arab JP, Carrieri P, Noureddin M, Alazawi W, Alkhouri N, Alqahtani SA, Anstee QM, Arrese M, Bataller R, Berg T, Brennan PN, Burra P, Castro-Narro GE, Cortez-Pinto H, Cusi K, Dedes N, Duseja A, Francque SM, Gastaldelli A, Hagström H, Huang TTK, Ivancovsky Wajcman D, Kautz A, Kopka CJ, Krag A, Newsome PN, Rinella ME, Romero D, Sarin SK, Silva M, Spearman CW, Terrault NA, Tsochatzis EA, Valenti L, Villota-Rivas M, Zelber-Sagi S, Schattenberg JM, Wong VW, and Younossi ZM

Subjects
Humans, Delivery of Health Care, Liver Diseases
Abstract

Background and Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care., Approach and Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over 2 rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities using Qualtrics XM, indicating agreement using a 4-point Likert-scale and providing written feedback. Priorities were revised between rounds, and in R2, panelists also ranked the priorities within 6 domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2, the mean percentage of "agree" responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% "agree"). The highest-ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance., Conclusions: This consensus-driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reduce the prevalence of fatty liver disease and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

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, 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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9. 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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10. A global research priority agenda to advance public health responses to fatty liver disease.

Author

Lazarus JV, Mark HE, Allen AM, Arab JP, Carrieri P, Noureddin M, Alazawi W, Alkhouri N, Alqahtani SA, Arrese M, Bataller R, Berg T, Brennan PN, Burra P, Castro-Narro GE, Cortez-Pinto H, Cusi K, Dedes N, Duseja A, Francque SM, Hagström H, Huang TT, Wajcman DI, Kautz A, Kopka CJ, Krag A, Miller V, Newsome PN, Rinella ME, Romero D, Sarin SK, Silva M, Spearman CW, Tsochatzis EA, Valenti L, Villota-Rivas M, Zelber-Sagi S, Schattenberg JM, Wong VW, and Younossi ZM

Subjects
Child, Humans, Adolescent, Public Health, Research, Global Health, Non-alcoholic Fatty Liver Disease epidemiology, Non-alcoholic Fatty Liver Disease prevention & control
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., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2023
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11. Combined COVID-19 vaccination and hepatitis C virus screening intervention in marginalised populations in Spain.

Author

Lazarus JV, Villota-Rivas M, Ryan P, Buti M, Grau-López L, Cuevas G, Espada JL, Morón W, Palma-Álvarez RF, Feld JJ, and Valencia J

Abstract

Background: COVID-19 has hindered hepatitis C virus (HCV) and HIV screening, particularly in marginalised groups, who have some of the highest rates of these conditions and lowest rates of COVID-19 vaccination. We assessed the acceptability of combining HCV testing with COVID-19 vaccination in a centre for addiction services (CAS) in Barcelona and a mobile testing unit (MTU) in Madrid, Spain., Methods: From 28/09/2021 to 30/06/2022, 187 adults from marginalised populations were offered HCV antibody (Ab) testing along with COVID-19 vaccination. If HCV Ab+, they were tested for HCV-RNA. MTU participants were also screened for HIV. HCV-RNA+ and HIV+ participants were offered treatment. Data were analysed descriptively., Results: Findings show how of the 86 CAS participants: 80 (93%) had been previously vaccinated for COVID-19, of whom 72 (90%) had the full first round schedule; none had a COVID-19 vaccine booster and all received a COVID-19 vaccine; 54 (62.8%) were tested for HCV Ab, of whom 17 (31.5%) were positive, of whom all were tested for HCV-RNA and none were positive. Of the 101 MTU participants: none had been vaccinated for COVID-19 and all received a COVID-19 vaccine; all were tested for HCV Ab and HIV and 15 (14.9%) and 9 (8.9%) were positive, respectively; of those HCV Ab+, 9 (60%) were HCV-RNA+, of whom 8 (88.9%) have started treatment; 5 (55.6%) of those HIV+ had abandoned antiretroviral therapy, of whom 3 (60%) have re-started it., Conclusions: The intervention was accepted by 54 (62.8%) CAS participants and all MTU participants and can be used in marginalised communities., (© 2023. The Author(s).)

Published
2023
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12. Physicians' Use of Digital Health Interventions in the Management of Nonalcoholic Fatty Liver Disease.

Author

Lazarus JV, Villota-Rivas M, Jiménez-González C, Santos-Laso A, Iruzubieta P, Arias-Loste MT, Rice-Duek L, Leigh S, Kopka CJ, Turnes J, Calleja JL, and Crespo J

Subjects
Humans, Liver, Life Style, Prevalence, Non-alcoholic Fatty Liver Disease therapy, Non-alcoholic Fatty Liver Disease epidemiology, Physicians
Abstract

Globally, the use of digital health interventions (DHIs) is expanding, along with growing scientific evidence of their effectiveness. Given the high and increasing prevalence of noncommunicable liver disease, we surveyed 295 physicians across Spain about their knowledge, beliefs, attitudes, practices, and access with regard to DHIs for patient care and in particular for liver diseases, including nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Physicians reported high familiarity with DHIs, although most had not recommended them in patient care. Addressing concerns, including limited available time, evidence of effectiveness, education, training, and access may contribute to an increased uptake of these technologies., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Published
2023
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13. The global NAFLD policy review and preparedness index: Are countries ready to address this silent public health challenge?

Author

Lazarus JV, Mark HE, 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 CW, Tacke F, Tsochatzis EA, Yilmaz Y, Younossi ZM, Wong VW, Zelber-Sagi S, Cortez-Pinto H, and Anstee QM

Subjects
Adult, Global Health, Humans, Obesity complications, Obesity epidemiology, Policy, Public Health, Non-alcoholic Fatty Liver Disease complications, Non-alcoholic Fatty Liver Disease diagnosis, Non-alcoholic Fatty Liver Disease epidemiology
Abstract

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., Competing Interests: Conflict of interest HEM, MV-R, and AP report receiving consulting fees from the EASL International Liver Foundation related to this work. The EASL International Liver Foundation received grants from Intercept, Bristol-Myers-Squibb Company, Genfit, and MSD to support this study. The funders played no role in the conceptualisation, design, data collection, analysis, decision to publish, or preparation of the manuscript. All other authors declare no relevant completing interests. Please refer to the accompanying ICMJE disclosure forms for further details., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2022
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14. A cascade of care analysis on the elimination of hepatitis C from public hospitals in Madrid.

Author

Lazarus JV, Villota-Rivas M, Fernández I, Gea F, Ryan P, López SA, Guy D, Calleja JL, and García-Samaniego J

Abstract

Background: Direct-acting antivirals can cure ≥95% of hepatitis C virus (HCV) cases, but do not reach everyone in need. This cross-sectional study analyses the HCV cascade of care (CoC) in Madrid, Spain, in high-risk patients, to inform micro-elimination measures., Methods: From September 2019 to May 2021, data from medical records were collected and analysed from six public hospitals in Madrid, including seven adult, high-risk patient groups: patients in haemodialysis or pre-dialysis programmes, co-infected with HIV, with advanced liver disease (ALD), with hereditary haematological diseases, with transplants and people who inject drugs (PWID)., Results: Here we present an analysis of 3994 patients (68.8% male), 91.2% were tested for anti-HCV and 28.9% were positive. Of the total, 34.5% were tested for HCV-RNA and 62.4% of these were positive. Of those HCV-RNA positive, 98.0% were treatment-eligible: in 7.4%, treatment is ongoing and in 89.3% completed. Of the latter, 92.2% obtained a sustained virological response 12 weeks post treatment (SVR12). Of those with ongoing or completed treatment, 9.8% experienced loss to follow-up (LTFU) or had unknown SVR12, 50.3% developed hepatic and 20.3% extrahepatic complications. ALD patients had the highest proportion of HCV-RNA positives (32.5%). The lowest proportion of patients treated were PWID (85.2%)., Conclusions: Almost one in ten high-risk patients in six of Madrid's public hospitals remains untested for HCV antibodies. An almost equal percentage of those untested have experienced LTFU, with the highest proportion in PWID. This approach to monitoring the HCV CoC is vital to inform measures to eliminate HCV in hospitals., Competing Interests: Competing interestsThe authors declare no competing interests., (© The Author(s) 2022.)

Published
2022
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15. Eliminating hepatitis C on the Balearic Islands, Spain: a protocol for an intervention study to test and link people who use drugs to treatment and care.

Author

Lazarus JV, Herranz A, Picchio CA, Villota-Rivas M, Rodríguez A, Alonso JM, Moratinos A, Perrotta A, Tegeo E, Bibiloni F, Buti M, and Vilella À

Subjects
Antiviral Agents therapeutic use, Hepacivirus, Humans, Spain epidemiology, World Health Organization, Hepatitis C diagnosis, Hepatitis C drug therapy, Hepatitis C epidemiology, Pharmaceutical Preparations, Substance Abuse, Intravenous drug therapy, Substance Abuse, Intravenous epidemiology
Abstract

Introduction: The hepatitis C virus (HCV) is a highly infectious and deadly disease, affecting some 58 million people worldwide. Of the 1.13 million people living in the Balearic Islands, Spain, about 1350 individuals have untreated HCV. Of these, about 1120 (83%) are estimated to be people who use drugs (PWUD), who are one of the key at-risk groups for HCV infection globally. Carrying out micro-elimination approaches focused on this population is crucial to achieve the WHO goal of eliminating HCV by 2030. Thus, the primary objective of this study is to validate a model of care that simplifies the screening and linkage to HCV care pathways for PWUD on the Balearic Islands., Methods and Analysis: This intervention study will be implemented across 17 sites, in 4 different settings: addiction service centres (n=12), non-governmental organisation centres (n=3), a mobile methadone unit and a prison, with an estimated 3725 participants. Together with the healthcare staff at each centre, the intervention protocols will be adapted, focusing on four phases: recruitment and testing; linkage to care; treatment for those who test positive; and monitoring of sustained virological response 12 weeks after treatment and reinfection. The primary outcomes will be the number of tested and treated individuals and the secondary outcomes will include individuals lost at each step in the cascade of care. Descriptive analysis and multivariable logistic regression of the data will be undertaken., Ethics and Dissemination: The Hospital Clínic Barcelona, Spain, Ethics Committee approved this study on 18 February 2021 (HCB/2020/2018). Findings will be disseminated through peer-reviewed publications, conference presentations and social media. The results of this study could provide a model for targeting PWUD for HCV testing and treatment in the rest of Spain and in other settings, helping to achieve the WHO HCV elimination goal., Competing Interests: Competing interests: JVL reports grants, personal fees, and other from AbbVie and Gilead Sciences, personal fees from CEPHEID, GSK, Intercept and Janssen, and grants and personal fees from MSD, outside the submitted work. MB reports advisory fees from Gilead Sciences, Abbvie, GlaxoSmithKline and Assembly Biosciences and speaker fees from Gilead Sciences and Abbvie, outside of the submitted work. AV, AH, CAP, MV-R, AR, JMA, AM, AP, ET and FB have no competing interest to declare., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2021
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16. A Twitter discourse analysis of negative feelings and stigma related to NAFLD, NASH and obesity.

Author

Lazarus JV, Kakalou C, Palayew A, Karamanidou C, Maramis C, Natsiavas P, Picchio CA, Villota-Rivas M, Zelber-Sagi S, and Carrieri P

Subjects
Emotions, Humans, Obesity, Social Stigma, Non-alcoholic Fatty Liver Disease, Social Media
Abstract

Background: People with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are stigmatized, partly since 'non-alcoholic' is in the name, but also because of obesity, which is a common condition in this group. Stigma is pervasive in social media and can contribute to poorer health outcomes. We examine how stigma and negative feelings concerning NAFLD/NASH and obesity manifest on Twitter., Methods: Using a self-developed search terms index, we collected NAFLD/NASH tweets from May to October 2019 (Phase I). Because stigmatizing NAFLD/NASH tweets were limited, Phase II focused on obesity (November-December 2019). Via sentiment analysis, >5000 tweets were annotated as positive, neutral or negative and used to train machine learning-based Natural Language Processing software, applied to 193 747 randomly sampled tweets. All tweets collected were analysed., Results: In Phase I, 16 835 tweets for NAFLD and 2376 for NASH were retrieved. Of the annotated NAFLD/NASH tweets, 97/1130 (8.6%) and 63/535 (11.8%), respectively, related to obesity and 13/1130 (1.2%) and 5/535 (0.9%), to stigma; they primarily focused on scientific discourse and unverified information. Of the 193 747 non-annotated obesity tweets (Phase II), the algorithm classified 40.0% as related to obesity, of which 85.2% were negative, 1.0% positive and 13.7% neutral., Conclusions: NAFLD/NASH tweets mostly indicated an unmet information need and showed no clear signs of stigma. However, the negative content of obesity tweets was recurrent. As obesity-related stigma is associated with reduced care engagement and lifestyle modification, the main NAFLD/NASH treatment, stigma-reducing interventions in social media should be included in the liver health agenda., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Published
2021
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