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

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.)