The global NAFLD policy review and preparedness index: Are countries ready to address this silent public health challenge?

Lazarus, Jeffrey V.; Mark, Henry E.; Villota-Rivas, Marcela; Palayew, Adam; Carrieri, Patrizia; Colombo, Massimo; Ekstedt, Mattias; Esmat, Gamal; George, Jacob; Marchesini, Giulio; Novak, Katarina; Ocama, Ponsiano; Ratziu, Vlad; Razavi, Homie; Romero–Gómez, Manuel; Silva, Marcelo; Spearman, C Wendy; Tacke, Frank; Tsochatzis, Emmanuel; Yılmaz, Yusuf; Younossi, Zobair M.; Wong, Vincent Wai‐Sun; Zelber‐Sagi, Shira; Cortez‐Pinto, Helena; Anstee, Quentin M.

doi:10.1016/j.jhep.2021.10.025

Cited by 134 publications

(122 citation statements)

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“…The NASH recipients displayed good long-term post-operative survival. Although a NASH epidemic represents a serious health problem, institutions and countries are not well-prepared to address this in many fields of medicine [25], including also the liver transplant setting. The results provided by our study should be useful for improving our knowledge in this field and to prepare us to face this upcoming challenge.…”

Section: Discussionmentioning

confidence: 99%

Nash Up, Virus Down: How the Waiting List Is Changing for Liver Transplantation: A Single Center Experience from Italy

et al. 2022

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Background and Objectives: Non-alcoholic steatohepatitis (NASH) has become the leading indication for liver transplantation in many countries, with a growing rate in the Western world. NASH patients are older and share a higher risk of comorbidities and cancer than patients with viral and/or alcoholic etiologies. The aims of this study were to evaluate waiting list (WL) registration and liver transplantation rates in patients with NASH-related cirrhosis at Padua University Hospital in the last fifteen years (1.2006–6.2020) and to compare clinical characteristics and indications for liver transplantation between patients with and without NASH, as well as the WL survival and post-transplant outcome. Materials and Methods: All adult patients with cirrhosis listed for liver transplantation at Padua University Hospital between 1.2006 and 6.2020 were retrospectively collected using a prospectively updated database; patients with NASH-related cirrhosis were divided by indication for liver transplantation (Dec-NASH vs. hepatocellular carcinoma (HCC)-NASH) and compared with patients with other etiologies of liver disease. The outcomes in terms of waiting list survival and post-transplant outcome were assessed. Results: One thousand four hundred and ninety-one adult cirrhotic patients were waitlisted during the study period. NASH patients accounted for 12% of all WL registrations, showing an increasing trend over time (from 2.5% in 2006 to 23% in 2020). In the last five years, NASH was the third, but most rapidly growing, indication for liver transplantation at our center. This trend was confirmed both for patients with decompensated cirrhosis (from 1.8% to 18%) and HCC as leading indication for transplantation (from 4% to 30%). NASH patients were older than non-NASH ones (mean ± SD age 59 ± 9 vs. 56 ± 9 years; p < 0.01), whereas no difference was found in gender or Child-Pugh of the model for end-stage liver disease score at WL registration. A majority (60.9%) of NASH patients underwent liver transplantation, showing 1-, 5- and 10-y post-transplant survivals of 86%, 73% and 60%, respectively. Conclusion: NASH cirrhosis has become a rapidly growing indication for liver transplantation at our center, both for HCC and decompensated disease, with good post-transplant survival.

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Section: Discussionmentioning

confidence: 99%

Nash Up, Virus Down: How the Waiting List Is Changing for Liver Transplantation: A Single Center Experience from Italy

et al. 2022

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“…While NAFL is a milder condition, NASH covers a wide spectrum of disease severity, including fibrosis, cirrhosis and hepatocellular carcinoma (HCC). (Lazarus et al, 2021). Now the term metabolic associated fatty liver disease (MAFLD) has been adopted, instead of NAFLD/NASH, chosen by a group of experts (Eslam et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Platelets in Non-alcoholic Fatty Liver Disease

et al. 2022

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Non alcoholic steatohepatitis (NASH) is the inflammatory reaction of the liver to excessive accumulation of lipids in the hepatocytes. NASH can progress to cirrhosis and hepatocellular carcinoma (HCC). Fatty liver is the hepatic manifestation of metabolic syndrome. A subclinical inflammatory state is present in patients with metabolic alterations like insulin resistance, type-2 diabetes, obesity, hyperlipidemia, and hypertension. Platelets participate in immune cells recruitment and cytokines-induced liver damage. It is hypothesized that lipid toxicity cause accumulation of platelets in the liver, platelet adhesion and activation, which primes the immunoinflammatory reaction and activation of stellate cells. Recent data suggest that antiplatelet drugs may interrupt this cascade and prevent/improve NASH. They may also improve some metabolic alterations. The pathophysiology of inflammatory liver disease and the implication of platelets are discussed in details.

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“…The authors reported the results of responses from representatives (mainly Hepatologists) from 102 countries, covering 86% of the global population. 14 The highest scoring country was India (42.7) and 32 countries scored zero. The findings contained in their paper led the authors to conclude that 'although NAFLD is a pressing public health problem, no country was found to be well prepared to address it'.…”

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confidence: 99%

“…In this edition of the Journal, Lazarus et al have further developed and extended their European preparedness index 13 and have developed their 'index' to accommodate 6 domains. 14 These domains covered: a) policy; b) guidelines; c) civil awareness and society engagement; d) epidemiology and data; e) detection and f) care. Responses were rated high, medium, and low; and a multiple correspondence analysis was then applied.…”

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confidence: 99%

“…It is disappointing (but not surprising) to note that only 20 (24%) of the 83 countries who reported having guidelines for diabetes, mentioned NAFLD in these guidelines. 14 This may be because T2DM potentially affects almost every bodily organ system, and many diabetologists view 'a little bit of liver fat' as the least of the patients' worries. To address questions about the significance of hepatic steatosis, researchers will need to generate the necessary evidence to support cost-effective case-finding strategies for NAFLD.…”

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confidence: 99%

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