European ‘NAFLD Preparedness Index’ — Is Europe ready to meet the challenge of fatty liver disease?

Jeffrey V. Lazarus, Adam Palayew, Patrizia Carrieri, Mattias Ekstedt, Giulio Marchesini, Katja Novak, Vlad Ratziu, Manuel Romero-Gómez, Frank Tacke, Shira Zelber-Sagi, Helena Cortez-Pinto, Quentin M. Anstee

Research output: Contribution to journalArticlepeer-review

Abstract

Background & Aims: Non-alcoholic fatty liver disease (NAFLD), which is closely associated with obesity, metabolic syndrome, and diabetes, is a highly prevalent emerging condition that can be optimally managed through a multidisciplinary patient-centred approach. National preparedness to address NAFLD is essential to ensure that health systems can deliver effective care. We present a NAFLD Preparedness Index for Europe. Methods: In June 2019, data were extracted by expert groups from 29 countries to complete a 41-item questionnaire about NAFLD. Questions were classified into 4 categories: policies/civil society (9 questions), guidelines (16 questions), epidemiology (4 questions), and care management (12 questions). Based on the responses, national preparedness for each indicator was classified into low, middle, or high-levels. We then applied a multiple correspondence analysis to obtain a standardised preparedness score for each country ranging from 0 to 100. Results: The analysis estimated a summary factor that explained 71.3% of the variation in the dataset. No countries were found to have yet attained a high-level of preparedness. Currently, the UK (75.5) scored best, although falling within the mid-level preparedness band, followed by Spain (56.2), and Denmark (43.4), whereas Luxembourg and Ireland were the lowest scoring countries with a score of 4.9. Only Spain scored highly in the epidemiology indicator category, whereas the UK was the only country that scored highly for care management. Conclusions: The NAFLD Preparedness Index indicates substantial variation between countries’ readiness to address NAFLD. Notably, even those countries that score relatively highly exhibit deficiencies in key domains, suggesting that structural changes are needed to optimise NAFLD management and ensure effective public health approaches are in place. Lay summary: Non-alcoholic fatty liver disease (NAFLD), which is closely associated with obesity, metabolic syndrome, and diabetes, is a highly prevalent condition that can be optimally managed through a multidisciplinary patient-centred approach. National preparedness to address NAFLD is essential to allow for effective public health measures aimed at preventing disease while also ensuring that health systems can deliver effective care to affected populations. This study defined preparedness as having adequate policies and civil society engagement, guidelines, epidemiology, and care management. NAFLD preparedness was found to be deficient in all 29 countries studied, with great variation among the countries and the 4 categories studied.

Original languageEnglish
Article number100234
JournalJHEP Reports
Volume3
Issue number2
DOIs
StatePublished - Apr 2021

Bibliographical note

Funding Information:
The original data collection was funded by the EASL International Liver Foundation with support from Gilead Sciences Europe Ltd. , Allergan Pharmaceutical International Ltd. , Bristol-Myers-Squibb Company , Pfizer Inc. , and Resoundant Inc . The statistical analysis was funded by the EASL International Liver Foundation with support from Bristol-Myers-Squibb Company , Intercept, and Genfit. JVL is supported by a Spanish Ministry of Science , Innovation and Universities Miguel Servet grant ( Instituto de Salud Carlos III/ESF , European Union [ CP18/00074 ]) and further acknowledges institutional support from the Spanish Ministry of Science, Innovation and Universities through the ‘Centro de Excelencia Severo Ochoa 2019–2023’ Programme ( CEX2018-000806-S ), and support from the Government of Catalonia through the CERCA Programme. QMA and VR are members of the EPoS (Elucidating Pathways of Steatohepatitis) consortium funded by the Horizon 2020 Framework Program of the European Union under Grant Agreement 634413 . QMA, VR, HCP, ME, and MRG are members of the LITMUS (Liver Investigation: Testing Marker Utility in Steatohepatitis) consortium funded by the IMI2 Program of the European Union under Grant Agreement 777377 . QMA is a Newcastle NIHR Biomedical Research Centre investigator. AP, PC, GM, KN, FT, and SZS have no financial support statements to disclose.

Publisher Copyright:
© 2021 The Authors

Keywords

  • Europe
  • Health policy
  • Liver health
  • Metabolic-associated fatty liver disease
  • Multiple joint correspondence analysis
  • Non-alcoholic fatty liver disease
  • Non-alcoholic steatohepatitis
  • Policy preparedness

ASJC Scopus subject areas

  • Internal Medicine
  • Immunology and Allergy
  • Hepatology
  • Gastroenterology

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