A global research priority agenda to advance public health responses to fatty liver disease

• Published in: Journal of hepatology Vol. 79; no. 3; pp. 618 - 634
• Main Authors: Allen, Alina M., Alqahtani, Saleh A., Arrese, Marco, Castro-Narro, Graciela E., Dedes, Nikos, Duseja, Ajay, Huang, Terry T.-K., Kautz, Achim, Newsome, Philip N., Rinella, Mary E., Sarin, Shiv Kumar, Valenti, Luca, Schattenberg, Jörn M., Younossi, Zobair M., Hagström, Hannes, Wajcman, Dana Ivancovsky, Krag, Aleksander, Silva, Marcelo, Al-Naamani, Khalid, Allison, Michael, Alnaser, Faisal A., Alswat, Khalid, Awuku, Yaw Asante, Baatarkhuu, Oidov, Bakieva, Shokhista, Barouki, Robert, Batterham, Rachel L., Berzigotti, Annalisa, Bianco, Cristiana, Brunt, Elizabeth M., Bugianesi, Elisabetta, Byrne, Christopher J., Castillo-López, Maria Gabriela, Coppell, Kirsten, Cotrim, Helma P., Crespo, Javier, Demir, Münevver, Dirac, M. Ashworth, Elsanousi, Osama M., Elsharkawy, Ahmed M., Eskridge, Wayne, Freidman, Scott L., Gadano, Adrian, George, Jacob, Girala, Marcos, Goossens, Nicolas, Henry, Zachary, Hickman, Ingrid J., Isakov, Vasily A., Jornayvaz, François, Koek, Ger, Kondili, Loreta A., Kotsiliti, Eleni, Koulla, Yiannoula, Kugelmas, Marcelo, Lkhagvaa, Undram, Malekzadeh, Reza, Martínez Vázquez, Sophia E., Mateva, Lyudmila, Mato, José M., Mendive, Juan M., Mikolasevic, Ivana, Milovanovic, Tamara, Musso, Carla, Nava-González, Edna J., Negro, Francesco, Nersesov, Alexander V., Neuschwander-Tetri, Brent A., Ong, Janus P., Ong-Go, Arlinking, Onyekwere, Charles, Pais, Raluca, Panduro, Arturo, Paruk, Imran, Pérez-Escobar, Juanita, Marques Souza de Oliveira, Claudia Pinto, Rabiee, Atoosa, Ramji, Alnoor, Ratziu, Vlad, Romeo, Stefano, Rowe, Ian A., Serme, Abdel Karim, Sharvadze, Lali, Skrypnyk, Igor, Song, Myeong Jun, Sookoian, Silvia, Swain, Mark G., Tan, Soek-Siam, Tapper, Elliot B., Tiniakos, Dina, Torre, Aldo, Turcanu, Adela, Velarde Ruiz Velasco, Jose Antonio, Vilar-Gomez, Eduardo, Wattacheril, Julia
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2023; Elsevier
• Subjects: Adolescent; Child; Delphi method; Global Health; Humans; Life Sciences; Medicin och hälsovetenskap; NAFLD/NASH; Non-alcoholic Fatty Liver Disease - epidemiology; Non-alcoholic Fatty Liver Disease - prevention & control; Non-communicable disease (NCD); Public Health; Santé publique et épidémiologie; Steatotic liver disease; Global health; Non-communicable disease (NCD); NAFLD/NASH; Steatotic liver disease; Delphi method
• ISSN: 0168-8278; 1600-0641; 1600-0641
• DOI: 10.1016/j.jhep.2023.04.035

An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community. Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of ‘agree’ responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement (‘agree’ + ‘somewhat agree’); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% ‘agree’), 13 priorities had <80% ‘agree’, with greater reliance on ‘somewhat agree’ to achieve >90% combined agreement. Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community’s efforts to advance and accelerate responses to this widespread and fast-growing public health threat. An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat. •A large, global multidisciplinary panel reached high agreement levels on 28 fatty liver disease research priorities.•Priorities spanned a broad range of areas, from disease burden and health system responses to policy and treatment.•Consensus increased in all 6 research domains across two voting rounds, from 78.3 in R1 to 81.1 in R2.•The mean level of combined agreement (‘agree’ + ‘somewhat agree’) across all priorities in R2 was 97.7%.•All priorities had >90% combined agreement (‘agree’ + ‘somewhat agree’) and 5 of these achieved unanimous agreement. [Display omitted]