Publication

Summary

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.

Countries/Territories: Australia, China, Hong Kong, Indonesia, Japan, Republic of Korea, Malaysia, Mongolia, New Zealand, Singapore, Taiwan, Thailand, Armenia, Austria, Azerbaijan, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Italy, Kazakhstan, Kyrgyz Republic, Latvia, Lithuania, Luxembourg, Moldova (Republic of), Netherlands, North Macedonia, Norway, Poland, Portugal, Romania, Serbia, Slovak Republic, Slovenia, Spain, Sweden, Switzerland, Tajikistan, Turkey, Ukraine, United Kingdom, Uzbekistan, Argentina, Aruba, Bahamas, Bolivia, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Peru, Puerto Rico, Algeria, Bahrain, Egypt, Iran (Islamic Republic of), Israel, Kuwait, Lebanon, Libya, Morocco, Oman, Qatar, Saudi Arabia, Tunisia, United Arab Emirates, Canada, United States, Bangladesh, India, Nepal, Pakistan, Sri Lanka, Benin, Botswana, Burkina Faso, Cabo Verde, Central African Republic, Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Malawi, Nigeria, South Africa, Sudan, Uganda, Zambia