European ‘NAFLD Preparedness Index’ — Is Europe ready to meet the challenge of fatty liver disease?

Abstract

Background & Aims: Non-alcoholic fatty liver disease (NAFLD), which is closely associated with obesity, metabolic syndrome,
\nand diabetes, is a highly prevalent emerging condition that can be optimally managed through a multidisciplinary patient centred approach. National preparedness to address NAFLD is essential to ensure that health systems can deliver effective
\ncare. We present a NAFLD Preparedness Index for Europe.
\nMethods: In June 2019, data were extracted by expert groups from 29 countries to complete a 41-item questionnaire about
\nNAFLD. Questions were classified into 4 categories: policies/civil society (9 questions), guidelines (16 questions), epidemiology
\n(4 questions), and care management (12 questions). Based on the responses, national preparedness for each indicator was
\nclassified into low, middle, or high-levels. We then applied a multiple correspondence analysis to obtain a standardised
\npreparedness score for each country ranging from 0 to 100.
\nResults: The analysis estimated a summary factor that explained 71.3% of the variation in the dataset. No countries were
\nfound to have yet attained a high-level of preparedness. Currently, the UK (75.5) scored best, although falling within the mid level preparedness band, followed by Spain (56.2), and Denmark (43.4), whereas Luxembourg and Ireland were the lowest
\nscoring countries with a score of 4.9. Only Spain scored highly in the epidemiology indicator category, whereas the UK was the
\nonly country that scored highly for care management.
\nConclusions: The NAFLD Preparedness Index indicates substantial variation between countries’ readiness to address NAFLD.
\nNotably, even those countries that score relatively highly exhibit deficiencies in key domains, suggesting that structural
\nchanges are needed to optimise NAFLD management and ensure effective public health approaches are in place.
\nLay summary: Non-alcoholic fatty liver disease (NAFLD), which is closely associated with obesity, metabolic syndrome, and
\ndiabetes, is a highly prevalent condition that can be optimally managed through a multidisciplinary patient-centred approach.
\nNational preparedness to address NAFLD is essential to allow for effective public health measures aimed at preventing disease
\nwhile also ensuring that health systems can deliver effective care to affected populations. This study defined preparedness as
\nhaving adequate policies and civil society engagement, guidelines, epidemiology, and care management. NAFLD preparedness
\nwas found to be deficient in all 29 countries studied, with great variation among the countries and the 4 categories studied.