1 Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Spain. Electronic address: Jeffrey.Lazarus@ISGlobal.org.
2 Department of Gastroenterology and Hepatology. Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
3 Department of Medical & Surgical Sciences, "Alma Mater" University, Bologna, Italy.
4 EASL International Liver Foundation, Geneva, Switzerland.
5 University Medical Center Ljubljana, Dept. of Gastroenterology, Slovenia.
6 Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Spain; Translational Research Group on Infectious Diseases of Lleida (TRIDLE), Infectious Diseases Clinical Direction, Biomedical Research Institute Dr Pifarré, University of Lleida, Lleida, Spain.
7 Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Spain; Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain.
8 UCM Digestive Diseases, ciberehd and IBIS, Virgen del Rocío University Hospital, University of Seville, Seville, Spain.
9 Pitie-Salpetriere Hospital, Department of Hepatology University Paris 6, France.
10 Department of Hepatology/Gastroenterology, Charité University Medical Center, Berlin, Germany.
11 Departamento de Gastrenterologia, CHLN, Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Portugal.
12 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; The Liver Unit & NIHR Biomedical Research Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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).
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.
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 livercirrhosis. 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 three countries (10%) had national registries that include NAFLD.
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 organization, including registries. Lay summary: We conducted a survey on NAFLD 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.