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.

中文翻译：

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全球 NAFLD 政策审查和准备指数：各国准备好应对这一无声的公共卫生挑战了吗？

背景与目标

非酒精性脂肪性肝病 (NAFLD) 是一种高度普遍但在很大程度上被低估的肝脏疾病，它与肥胖和代谢疾病密切相关。尽管全球估计有四分之一的成年人受到 NAFLD 的影响，但 NAFLD 基本上没有出现在国家和全球卫生议程中。

方法

我们收集了来自 102 个国家（占世界人口的 86%）的关于 NAFLD 政策、指南、民间社会参与、临床管理和流行病学数据的数据。通过将问题编码为 6 个领域（政策、指南、公民意识、流行病学和数据、NAFLD 检测和 NAFLD 护理管理）并将响应分类为高、中和低，开发了一个准备指数；然后应用多重对应分析。

结果

得分最高的国家是印度（42.7）和英国（40.0），32 个国家（31%）在 100 分中得分为零。在 5 个领域中，少数国家被归类为高水平，而大多数国家被归类作为低级。没有一个国家制定了针对 NAFLD 的国家或次国家战略，并且在针对相关疾病的不同战略中，<2% 的国家都提到了 NAFLD。国家 NAFLD 临床指南仅存在于 32 个国家。

结论

尽管 NAFLD 是一个紧迫的公共卫生问题，但没有发现任何国家准备好应对它。迫切需要在国家和全球层面解决 NAFLD 的战略。

总结

大约三分之一的国家在 NAFLD 政策准备指数上得分为零，没有一个国家得分超过 50/100。尽管 NAFLD 是一个紧迫的公共卫生问题，但所有 102 个国家都缺乏全面的公共卫生应对措施。迫切需要在国家和全球层面解决 NAFLD 的政策和战略。