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A cross-sectional study of the public health response to non-alcoholic fatty liver disease in Europe
Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Spain.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Gastroentorology.
Department of Medical and Surgical Sciences, “Alma Mater” University, Bologna, Italy.
EASL International Liver Foundation, Geneva, Switzerland.
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2020 (English)In: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 72, no 1, p. 14-24Article in journal (Refereed) Published
Abstract [en]

Background & Aims

Non-alcoholic fatty liver disease (NAFLD) is a growing public health problem worldwide and has become an important field of biomedical inquiry. We aimed to determine whether European countries have mounted an adequate public health response to NAFLD and non-alcoholic steatohepatitis (NASH).

Methods

In 2018 and 2019, NAFLD experts in 29 European countries completed an English-language survey on policies, guidelines, awareness, monitoring, diagnosis and clinical assessment in their country. The data were compiled, quality checked against existing official documents and reported descriptively.

Results

None of the 29 participating countries had written strategies or action plans for NAFLD. Two countries (7%) had mentions of NAFLD or NASH in related existing strategies (obesity and alcohol). Ten (34%) reported having national clinical guidelines specifically addressing NAFLD and, upon diagnosis, all included recommendations for the assessment of diabetes and liver cirrhosis. Eleven countries (38%) recommended screening for NAFLD in all patients with either diabetes, obesity and/or metabolic syndrome. Five countries (17%) had referral algorithms for follow-up and specialist referral in primary care, and 7 (24%) reported structured lifestyle programmes aimed at NAFLD. Seven (24%) had funded awareness campaigns that specifically included prevention of liver disease. Four countries (14%) reported having civil society groups which address NAFLD and 3 countries (10%) had national registries that include NAFLD.

Conclusions

We found that a comprehensive public health response to NAFLD is lacking in the surveyed European countries. This includes policy in the form of a strategy, clinical guidelines, awareness campaigns, civil society involvement, and health systems organisation, including registries.

Lay summary

We conducted a survey on non-alcoholic fatty liver disease with experts in European countries, coupled with data extracted from official documents on policies, clinical guidelines, awareness, and monitoring. We found a general lack of national policies, awareness campaigns and civil society involvement, and few epidemiological registries.

Place, publisher, year, edition, pages
Elsevier, 2020. Vol. 72, no 1, p. 14-24
Keywords [en]
Europe; Guidelines as topic; Health Policy; Non-alcoholic fatty liver disease (NAFLD); Non-alcoholic steatohepatitis (NASH); Review
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:liu:diva-162974DOI: 10.1016/j.jhep.2019.08.027ISI: 000503041200005PubMedID: 31518646Scopus ID: 2-s2.0-85074504519OAI: oai:DiVA.org:liu-162974DiVA, id: diva2:1382393
Note

Funding agencies:  EASL International Liver Foundation from Gilead Sciences Europe Ltd.; Allergan Pharmaceutical International Ltd.Allergan; Bristol-Myers-Squibb CompanyBristol-Myers Squibb; Pfizer Inc.Pfizer; Resoundant Inc.; Miguel Servet; Horizon 2020 Framework Program o

Available from: 2020-01-02 Created: 2020-01-02 Last updated: 2020-02-05Bibliographically approved

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