Advancing the global public health agenda for NAFLD: a consensus statement

doi:10.1038/s41575-021-00523-4

Review

. 2022 Jan;19(1):60-78.

doi: 10.1038/s41575-021-00523-4. Epub 2021 Oct 27.

Advancing the global public health agenda for NAFLD: a consensus statement

Jeffrey V Lazarus^{1

2}, Henry E Mark³, Quentin M Anstee^{4

5}, Juan Pablo Arab⁶, Rachel L Batterham⁷, Laurent Castera⁸, Helena Cortez-Pinto⁹, Javier Crespo¹⁰, Kenneth Cusi¹¹, M Ashworth Dirac¹², Sven Francque^{13

14}, Jacob George¹⁵, Hannes Hagström¹⁶, Terry T-K Huang¹⁷, Mona H Ismail¹⁸, Achim Kautz¹⁹, Shiv Kumar Sarin²⁰, Rohit Loomba^{21

22}, Veronica Miller²³, Philip N Newsome²⁴, Michael Ninburg²⁵, Ponsiano Ocama²⁶, Vlad Ratziu²⁷, Mary Rinella²⁸, Diana Romero²⁹, Manuel Romero-Gómez³⁰, Jörn M Schattenberg³¹, Emmanuel A Tsochatzis^{32

33}, Luca Valenti^{34

35}, Vincent Wai-Sun Wong³⁶, Yusuf Yilmaz^{37

38}, Zobair M Younossi³⁹, Shira Zelber-Sagi^{40

41}; NAFLD Consensus Consortium

Collaborators, Affiliations

Collaborators

NAFLD Consensus Consortium:
Fredrik Åberg, Leon Adams, Maryam Salem Al Khatry, Khalid Al Naamani, Omar Alfaro Murillo, Alina M Allen, Faisal Alnaser, Saleh A Alqahtani, Khalid Alswat, Domenico Alvaro, Raúl J Andrade, Marco Arrese, Yaw Asante Awuku, Motala Ayesha, Oidov Baatarkhuu, Shokhista Bakieva, Rita Basu, Ramon Bataller, Shahinaz Bedri, Emanuele Bosi, Marc Bourliere, Radan Bruha, Elisabetta Bugianesi, Patrizia Burra, Maria Buti, Christopher D Byrne, Jose Luis Calleja, Patrizia Carrieri, Flloyd Carter, Marlen Ivon Castellanos Fernandez, Gabriela Castillo-Lopez, Graciela E Castro-Narro, Henry Lik Yuen Chan, Wah-Kheong Chan, Yoosoo Chang, Massimo Colombo, Kirsten J Coppell, Kathleen Corey, Antonio Craxi, Donna Cryer, Anuradha Dassanayake, Antonieta de Ascenção Soares Martins, Victor de Ledinghen, Stefano DelPrato, Alessandro Demaio, Hailemichael Desalegn, John Dillon, Ajay Duseja, Prabhakaran Dorairaj, Mattias Ekstedt, Mohamed El Kassas, Osama M Elsanousi, Gamal Esmat, Jian-Gao Fan, Nathalie Farpour-Lambert, Robert Flisiak, Yasser Fouad, Michael Fuchs, Rino A Gani, Lynn Gerber, Hasmik Ghazinyan, Liana Gheorghe, George Boon-Bee Goh, Henning Grønbæk, Aghayeva Gulnara, Saeed Hamid, Vanessa Hebditch, Ingrid J Hickman, Samantha L Hocking, Bela Hunyady, Ramazan Idilman, Vasily A Isakov, Mohammad H Jamal, Peter Jepsen, Natacha Jreige Iskandar, Myeong Jun Song, K C Sudhamshu, Satoru Kakizaki, George Kalamitsis, Fasiha Kanwal, Jia-Horng Kao, Lee Kaplan, Takumi Kawaguchi, Yousef Khader, Seung Up Kim, Nicolas Kodjoh, Ger Koek, Kazuhiko Koike, Narcisse Patrice Komas, Marko Korenjak, Marcelo Kugelmas, Asma Labidi, Naomi F Lange, Joel E Lavine, Mariana Lazo, Nancy Lee, Cosmas Rinaldi A Lesmana, Chun-Jen Liu, Michelle T Long, Patricio Lopez-Jaramillo, Reza Malekzadeh, Mamun Al Mahtab, Giulio Marchesini, Rui Marinho, Sophia E Martínez Vázquez, Lyudmila Mateva, Charles Mbendi Nlombi, Pascal Melin, Ivana Mikolasevic, Tamara Milovanovic, Carla Musso, Atsushi Nakajima, Edna Nava, Alexander V Nersesov, Dafina Nikolova, Suzanne Norris, Katja Novak, Jude Oben, Janus P Ong, Charles Onyekwere, George Papatheodoridis, Imran Paruk, Keyur Patel, M Paula Macedo, Carlos Penha-Gonçalves, Marlene Pérez Figueroa, Wolf Peter Hofmann, Salvatore Petta, Claudia Pinto Marques Souza de Oliveira, Puneet Puri, Calvin Q Pan, Marek Rac, Johanna Ralston, Alnoor Ramji, Homie Razavi, Mario Reis Alvares-da-Silva, Stuart Roberts, Michael Roden, Tamsin Rose, Samir Rouabhia, Patrizia Rovere-Querini, Ian A Rowe, Shakhlo Sadirova, Riina Salupere, Tobokalova Saparbu, Raymond Sayegh, Giada Sebastiani, Yosuke Seki, Josefina Selmo, Abdel Karim Serme, Jonathan E Shaw, Thrivikrama Shenoy, Nick Sheron, Oren Shibolet, Marcelo Silva, Igor Skrypnyk, Piotr Socha, Joan Soriano, C Wendy Spearman, Kannan Sridharan, Juan José Suárez, Dhastagir Sultan Sheriff, Ki-Chul Sung, Mark Swain, Frank Tacke, Shahrad Taheri, Soek-Siam Tan, Elliot B Tapper, Hannele Yki-Järvinen, Maja Thiele, Isaac Thom Shawa, Ieva Tolmane, Esther A Torres, Michael Trauner, Sombat Treeprasertsuk, Adela Turcanu, Jonas Valantinas, Mette Vesterhus, Imam Waked, Sarah H Wild, Jose Willemse, Robert J Wong, Stavra Xanthakos, Dan Yock Young, Ming-Lung Yu, Kenneth I Zheng, Mudjat Zeybel, Ming-Hua Zheng

Affiliations

¹ Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain. Jeffrey.Lazarus@isglobal.org.
² EASL International Liver Foundation, Geneva, Switzerland. Jeffrey.Lazarus@isglobal.org.
³ EASL International Liver Foundation, Geneva, Switzerland.
⁴ Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
⁵ Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
⁶ Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
⁷ Centre for Obesity Research, University College London and National Institute of Health Research, UCLH Biomedical Research Centre, London, UK.
⁸ Department of Hepatology, Hôpital Beaujon, Université de Paris, Paris, France.
⁹ Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
¹⁰ Gastroenterology and Heptology Unit, Hospital Universitario Marqués de Valdecilla, Santander, IDIVAL, Santander, Spain.
¹¹ Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Veterans Health Administration and University of Florida, Gainesville, FL, USA.
¹² Department of Health Metrics Sciences, Department of Family Medicine, University of Washington, Seattle, WA, USA.
¹³ Department of Gastroenterology Hepatology, University Hospital Antwerp, Antwerp, Belgium.
¹⁴ Translational Sciences in Inflammation and Immunology TWI2N, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
¹⁵ Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia.
¹⁶ Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
¹⁷ Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.
¹⁸ Division of Gastroenterology, Department of Internal Medicine, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
¹⁹ Kautz5, Köln, Germany.
²⁰ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
²¹ Department of Medicine, NAFLD Research Center, La Jolla, CA, USA.
²² Department of Medicine, University of California San Diego, La Jolla, CA, USA.
²³ University of California Berkeley, School of Public Health, Forum for Collaborative Research, Washington, DC, USA.
²⁴ National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK.
²⁵ Hepatitis Education Project, Seattle, WA, USA.
²⁶ Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
²⁷ Assistance Publique-Hôpitaux de Paris, Hôpital Pitie-Salpetriere, University of Paris, Paris, France.
²⁸ Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
²⁹ Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
³⁰ UCM Digestive Diseases, CIBEREHD and IBIS, Virgen del Rocío University Hospital, University of Seville, Seville, Spain.
³¹ Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Mainz, Germany.
³² University College London Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.
³³ Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.
³⁴ Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
³⁵ Precision Medicine, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
³⁶ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
³⁷ Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey.
³⁸ Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
³⁹ Center for Liver Diseases, Inova Medicine, Falls Church, VA, USA.
⁴⁰ University of Haifa, Faculty of Social Welfare and Health Sciences, School of Public Health, Mount Carmel, Haifa, Israel.
⁴¹ Department of Gastroenterology, Tel-Aviv Medical Centre, Tel-Aviv, Israel.

PMID: 34707258
DOI: 10.1038/s41575-021-00523-4

Free article

Review

Advancing the global public health agenda for NAFLD: a consensus statement

Jeffrey V Lazarus et al. Nat Rev Gastroenterol Hepatol. 2022 Jan.

Free article

. 2022 Jan;19(1):60-78.

doi: 10.1038/s41575-021-00523-4. Epub 2021 Oct 27.

Authors

Collaborators

NAFLD Consensus Consortium:
Fredrik Åberg, Leon Adams, Maryam Salem Al Khatry, Khalid Al Naamani, Omar Alfaro Murillo, Alina M Allen, Faisal Alnaser, Saleh A Alqahtani, Khalid Alswat, Domenico Alvaro, Raúl J Andrade, Marco Arrese, Yaw Asante Awuku, Motala Ayesha, Oidov Baatarkhuu, Shokhista Bakieva, Rita Basu, Ramon Bataller, Shahinaz Bedri, Emanuele Bosi, Marc Bourliere, Radan Bruha, Elisabetta Bugianesi, Patrizia Burra, Maria Buti, Christopher D Byrne, Jose Luis Calleja, Patrizia Carrieri, Flloyd Carter, Marlen Ivon Castellanos Fernandez, Gabriela Castillo-Lopez, Graciela E Castro-Narro, Henry Lik Yuen Chan, Wah-Kheong Chan, Yoosoo Chang, Massimo Colombo, Kirsten J Coppell, Kathleen Corey, Antonio Craxi, Donna Cryer, Anuradha Dassanayake, Antonieta de Ascenção Soares Martins, Victor de Ledinghen, Stefano DelPrato, Alessandro Demaio, Hailemichael Desalegn, John Dillon, Ajay Duseja, Prabhakaran Dorairaj, Mattias Ekstedt, Mohamed El Kassas, Osama M Elsanousi, Gamal Esmat, Jian-Gao Fan, Nathalie Farpour-Lambert, Robert Flisiak, Yasser Fouad, Michael Fuchs, Rino A Gani, Lynn Gerber, Hasmik Ghazinyan, Liana Gheorghe, George Boon-Bee Goh, Henning Grønbæk, Aghayeva Gulnara, Saeed Hamid, Vanessa Hebditch, Ingrid J Hickman, Samantha L Hocking, Bela Hunyady, Ramazan Idilman, Vasily A Isakov, Mohammad H Jamal, Peter Jepsen, Natacha Jreige Iskandar, Myeong Jun Song, K C Sudhamshu, Satoru Kakizaki, George Kalamitsis, Fasiha Kanwal, Jia-Horng Kao, Lee Kaplan, Takumi Kawaguchi, Yousef Khader, Seung Up Kim, Nicolas Kodjoh, Ger Koek, Kazuhiko Koike, Narcisse Patrice Komas, Marko Korenjak, Marcelo Kugelmas, Asma Labidi, Naomi F Lange, Joel E Lavine, Mariana Lazo, Nancy Lee, Cosmas Rinaldi A Lesmana, Chun-Jen Liu, Michelle T Long, Patricio Lopez-Jaramillo, Reza Malekzadeh, Mamun Al Mahtab, Giulio Marchesini, Rui Marinho, Sophia E Martínez Vázquez, Lyudmila Mateva, Charles Mbendi Nlombi, Pascal Melin, Ivana Mikolasevic, Tamara Milovanovic, Carla Musso, Atsushi Nakajima, Edna Nava, Alexander V Nersesov, Dafina Nikolova, Suzanne Norris, Katja Novak, Jude Oben, Janus P Ong, Charles Onyekwere, George Papatheodoridis, Imran Paruk, Keyur Patel, M Paula Macedo, Carlos Penha-Gonçalves, Marlene Pérez Figueroa, Wolf Peter Hofmann, Salvatore Petta, Claudia Pinto Marques Souza de Oliveira, Puneet Puri, Calvin Q Pan, Marek Rac, Johanna Ralston, Alnoor Ramji, Homie Razavi, Mario Reis Alvares-da-Silva, Stuart Roberts, Michael Roden, Tamsin Rose, Samir Rouabhia, Patrizia Rovere-Querini, Ian A Rowe, Shakhlo Sadirova, Riina Salupere, Tobokalova Saparbu, Raymond Sayegh, Giada Sebastiani, Yosuke Seki, Josefina Selmo, Abdel Karim Serme, Jonathan E Shaw, Thrivikrama Shenoy, Nick Sheron, Oren Shibolet, Marcelo Silva, Igor Skrypnyk, Piotr Socha, Joan Soriano, C Wendy Spearman, Kannan Sridharan, Juan José Suárez, Dhastagir Sultan Sheriff, Ki-Chul Sung, Mark Swain, Frank Tacke, Shahrad Taheri, Soek-Siam Tan, Elliot B Tapper, Hannele Yki-Järvinen, Maja Thiele, Isaac Thom Shawa, Ieva Tolmane, Esther A Torres, Michael Trauner, Sombat Treeprasertsuk, Adela Turcanu, Jonas Valantinas, Mette Vesterhus, Imam Waked, Sarah H Wild, Jose Willemse, Robert J Wong, Stavra Xanthakos, Dan Yock Young, Ming-Lung Yu, Kenneth I Zheng, Mudjat Zeybel, Ming-Hua Zheng

Affiliations

¹ Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain. Jeffrey.Lazarus@isglobal.org.
² EASL International Liver Foundation, Geneva, Switzerland. Jeffrey.Lazarus@isglobal.org.
³ EASL International Liver Foundation, Geneva, Switzerland.
⁴ Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
⁵ Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
⁶ Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
⁷ Centre for Obesity Research, University College London and National Institute of Health Research, UCLH Biomedical Research Centre, London, UK.
⁸ Department of Hepatology, Hôpital Beaujon, Université de Paris, Paris, France.
⁹ Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
¹⁰ Gastroenterology and Heptology Unit, Hospital Universitario Marqués de Valdecilla, Santander, IDIVAL, Santander, Spain.
¹¹ Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Veterans Health Administration and University of Florida, Gainesville, FL, USA.
¹² Department of Health Metrics Sciences, Department of Family Medicine, University of Washington, Seattle, WA, USA.
¹³ Department of Gastroenterology Hepatology, University Hospital Antwerp, Antwerp, Belgium.
¹⁴ Translational Sciences in Inflammation and Immunology TWI2N, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
¹⁵ Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia.
¹⁶ Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
¹⁷ Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.
¹⁸ Division of Gastroenterology, Department of Internal Medicine, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
¹⁹ Kautz5, Köln, Germany.
²⁰ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
²¹ Department of Medicine, NAFLD Research Center, La Jolla, CA, USA.
²² Department of Medicine, University of California San Diego, La Jolla, CA, USA.
²³ University of California Berkeley, School of Public Health, Forum for Collaborative Research, Washington, DC, USA.
²⁴ National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK.
²⁵ Hepatitis Education Project, Seattle, WA, USA.
²⁶ Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
²⁷ Assistance Publique-Hôpitaux de Paris, Hôpital Pitie-Salpetriere, University of Paris, Paris, France.
²⁸ Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
²⁹ Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
³⁰ UCM Digestive Diseases, CIBEREHD and IBIS, Virgen del Rocío University Hospital, University of Seville, Seville, Spain.
³¹ Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Mainz, Germany.
³² University College London Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.
³³ Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.
³⁴ Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
³⁵ Precision Medicine, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
³⁶ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
³⁷ Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey.
³⁸ Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
³⁹ Center for Liver Diseases, Inova Medicine, Falls Church, VA, USA.
⁴⁰ University of Haifa, Faculty of Social Welfare and Health Sciences, School of Public Health, Mount Carmel, Haifa, Israel.
⁴¹ Department of Gastroenterology, Tel-Aviv Medical Centre, Tel-Aviv, Israel.

PMID: 34707258
DOI: 10.1038/s41575-021-00523-4

Abstract

Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics - from epidemiology, awareness, care and treatment to public health policies and leadership - that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD.

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A multinational Delphi consensus to end the COVID-19 public health threat.
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References

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[1] Golabi, P. et al. Non-alcoholic fatty liver disease (NAFLD) is associated with impairment of health related quality of life (HRQOL). Health Qual. Life Outcomes 14, 18 (2016). - PubMed - PMC

[2] Golabi, P. et al. Non-alcoholic fatty liver disease (NAFLD) is associated with impairment of health related quality of life (HRQOL). Health Qual. Life Outcomes 14, 18 (2016). - PubMed - PMC

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[8] Schattenberg, J. M. et al. Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis (NASH) in five European countries in 2018: a cost-of-illness analysis. Liver Int. 41, 1227–1242 (2021). - PubMed - PMC

[9] Younossi, Z. M. et al. The association of histologic and noninvasive tests with adverse clinical and patient-reported outcomes in patients with advanced fibrosis due to nonalcoholic steatohepatitis. Gastroenterology https://doi.org/10.1053/j.gastro.2020.12.003 (2020). - DOI - PubMed

[10] Younossi, Z. M. et al. The association of histologic and noninvasive tests with adverse clinical and patient-reported outcomes in patients with advanced fibrosis due to nonalcoholic steatohepatitis. Gastroenterology https://doi.org/10.1053/j.gastro.2020.12.003 (2020). - DOI - PubMed

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Advancing the global public health agenda for NAFLD: a consensus statement

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Advancing the global public health agenda for NAFLD: a consensus statement

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