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The data collection and analysis were funded by the EASL International Liver Foundation with support from, Intercept, Bristol-Myers-Squibb Company, Genfit, and MSD. Data collection for the original European data was funded by the EASL International Liver Foundation supported by Gilead Sciences Europe Ltd., Allergan Pharmaceutical International Ltd., Bristol-Myers-Squibb Company, Pfizer Inc., and Resoundant Inc.

Analysis of institutional authors

Lazarus JvCorresponding AuthorVillota-Rivas MAuthor

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December 16, 2021
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Review

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

Publicated to:Journal Of Hepatology. 76 (4): 771-780 - 2022-04-01 76(4), DOI: 10.1016/j.jhep.2021.10.025

Authors: Lazarus, JV; Mark, HE; Villota-Rivas, M; Palayew, A; Carrieri, P; Colombo, M; Ekstedt, M; Esmat, G; George, J; Marchesini, G; Novak, K; Ocama, P; Ratziu, V; Razavi, H; Romero-Gómez, M; Silva, M; Spearman, CW; Tacke, F; Tsochatzis, EA; Yilmaz, Y; Younossi, ZM; Wong, VWS; Zelber-Sagi, S; Cortez-Pinto, H; Anstee, QM

Affiliations

Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France - Author
Aix Marseille Univ, Sci Econom & Soci Sante & Traitement Informat Med, ISSPAM, SESSTIM,INSERM,IRD, Marseille, France - Author
Algeria - Author
Armenia - Author
Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain, EASL International Liver Foundation, Geneva, Switzerland - Author
Belgium - Author
Bolivia - Author
Brazil - Author
Bulgaria - Author
Cairo Univ, Endem Med & Hepatol Dept, Fac Med, Cairo, Egypt - Author
Campus Charite Mitte, D-13353 Berlin, Germany - Author
Canada - Author
Charite, Dept Gastroenterol & Hepatol, Campus Virchow Klinikum, D-13353 Berlin, Germany - Author
China - Author
Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Peoples R China - Author
Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal - Author
Colombia - Author
Ctr Dis Anal Fdn, Lafayette, CO USA - Author
Czech Republic - Author
Denmark - Author
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden - Author
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong - Author
Easl Int Liver Fdn, Geneva, Switzerland - Author
EASL International Liver Foundation, Geneva, Switzerland - Author
Ecuador - Author
Estonia - Author
Finland - Author
Georgia - Author
GREECE - Author
Hosp Univ Austral, Hepatol & Liver Transplant Units, Buenos Aires, DF, Argentina - Author
India - Author
Indonesia - Author
Inova Med, Center Liver Dis, Falls Church, VA USA - Author
Iran - Author
IRCCS Azienda Osped Univ Bologna, Bologna, Italy - Author
IRCCS San Raffaele Hosp, Liver Ctr, Milan, Italy - Author
Kenya - Author
Latvia - Author
Linkoping Univ, Dept Hlth Med & Caring Sci, Linkoping, Sweden - Author
Lithuania - Author
Luxembourg - Author
Makerere Univ, Coll Hlth Sci, Kampala, Uganda - Author
Makerere University College of Health Sciences, Kampala, Uganda - Author
Marmara Univ, Dept Gastroenterol, Sch Med, Istanbul, Turkey - Author
Marmara Univ, Inst Gastroenterol, Liver Res Unit, Istanbul, Turkey - Author
Mexico - Author
Mongolia - Author
Morocco - Author
Nepal - Author
Netherlands - Author
Newcastle Tyne Hosp NHS Trust, Newcastle NIHR Biomed Res Ctr, Newcastle Upon Tyne, Tyne & Wear, England - Author
Newcastle Univ, Translat Clin Res Inst, Fac Med Sci, Newcastle Upon Tyne, Tyne & Wear, England - Author
Nigeria - Author
North Macedonia - Author
Peru - Author
Pitie-Salpetriere Hospital, Department of Hepatology University Paris, Paris, France - Author
Poland - Author
Romania - Author
South Korea - Author
Switzerland - Author
TAIWAN - Author
Tel Aviv Med Ctr & Sch Med, Dept Gastroenterol, Tel Aviv, Israel - Author
Thailand - Author
UCL Inst Liver & Digest Hlth, Royal Free Hosp, London, England - Author
UCL, London, England - Author
Ukraine - Author
Univ Barcelona, Barcelona Inst Global Hlth ISGlobal, Hosp Clin, Barcelona, Spain - Author
Univ Barcelona, Fac Med, Barcelona, Spain - Author
Univ Cape Town, Dept Med, Div Hepatol, Fac Hlth Sci, Cape Town, South Africa - Author
Univ Haifa, Sch Publ Hlth, Fac Social Welf & Hlth Sci, Haifa, Israel - Author
Univ Lisbon, Clin Univ Gastrenterol, Lab Nutricao, Fac Med, Lisbon, Portugal - Author
Univ Med Ctr Ljubljana, Dept Gastroenterol, Ljubljana, Slovenia - Author
Univ Paris, Pitie Salpetriere Hosp, Dept Hepatol, Paris, France - Author
Univ Seville, Virgen Rocio Univ Hosp Inst, Digest Dis & Ciberehd, Seville, Spain - Author
Univ Studi Bologna, Bologna, Italy - Author
Univ Sydney, Sydney, NSW, Australia - Author
Univ Washington, Dept Epidemiol, Seattle, WA USA - Author
University Medical Center Ljubljana, Department of Gastroenterology, Ljubljana, Slovenia - Author
Westmead Hosp, Westmead Inst Med Res, Storr Liver Ctr, Sydney, NSW, Australia - Author
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Abstract

Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent, yet largely underappreciated liver condition which is closely associated with obesity and metabolic disease. Despite affecting an estimated 1 in 4 adults globally, NAFLD is largely absent on national and global health agendas. Methods: We collected data from 102 countries, accounting for 86% of the world population, on NAFLD policies, guidelines, civil society engagement, clinical management, and epidemiologic data. A preparedness index was developed by coding questions into 6 domains (policies, guidelines, civil awareness, epidemiology and data, NAFLD detection, and NAFLD care management) and categorising the responses as high, medium, and low; a multiple correspondence analysis was then applied. Results: The highest scoring countries were India (42.7) and the United Kingdom (40.0), with 32 countries (31%) scoring zero out of 100. For 5 of the domains a minority of countries were categorised as high-level while the majority were categorised as low-level. No country had a national or sub-national strategy for NAFLD and <2% of the different strategies for related conditions included any mention of NAFLD. National NAFLD clinical guidelines were present in only 32 countries. Conclusions: Although NAFLD is a pressing public health problem, no country was found to be well prepared to address it. There is a pressing need for strategies to address NAFLD at national and global levels. Lay summary: Around a third of the countries scored a zero on the NAFLD policy preparedness index, with no country scoring over 50/100. Although NAFLD is a pressing public health problem, a comprehensive public health response is lacking in all 102 countries. Policies and strategies to address NAFLD at the national and global levels are urgently needed. © 2021 The Author(s)

Keywords

american associationcardiovascular-diseasediabetes-mellitusdiagnosisepidemiologyfibrosisglobal public healthhealth policyliver healthmanagementmultiple correspondence analysisnon-alcoholic steatohepatitis (nash)outcomespolicy preparednesspractice guidanceAdultFatty liver-diseaseGlobal healthGlobal public healthHealth policyHumansLiver healthMultiple correspondence analysisNon-alcoholic fatty liver diseaseNon-alcoholic fatty liver disease (nafld)Non-alcoholic steatohepatitis (nash)ObesityPolicyPolicy preparednessPublic health

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Hepatology due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 4/93, thus managing to position itself as a Q1 (Primer Cuartil), in the category Gastroenterology & Hepatology. Notably, the journal is positioned above the 90th percentile.

This publication has been distinguished as a “Highly Cited Paper” by the agencies WoS (ESI, Clarivate) and ESI (Clarivate), meaning that it ranks within the top 1% of the most cited articles in its thematic field during the year of its publication. In terms of the observed impact of the contribution, this work is considered one of the most influential worldwide, as it is recognized as highly cited. (source consulted: ESI Nov 14, 2024)

And this is evidenced by the extremely high normalized impacts through some of the main indicators of this type, which, although dynamic over time and dependent on the set of average global citations at the time of calculation, already indicate that they are well above the average in different agencies:

  • Normalization of citations relative to the expected citation rate (ESI) by the Clarivate agency: 17.86 (source consulted: ESI Nov 14, 2024)
  • Weighted Average of Normalized Impact by the Scopus agency: 13.26 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 76.37 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-18, the following number of citations:

  • WoS: 177
  • Scopus: 191
  • Europe PMC: 88

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-18:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 229.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 249 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 86.9.
  • The number of mentions on the social network X (formerly Twitter): 77 (Altmetric).
  • The number of mentions in news outlets: 6 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Algeria; Argentina; Armenia; Aruba; Australia; Austria; Azerbaijan; Bahamas; Bahrain; Bangladesh; Belgium; Benin; Bolivia; Botswana; Brazil; Bulgaria; Canada; Cape Verde; Central African Republic; China; Colombia; Congo; Costa Rica; Croatia; Cyprus; Czech Republic; Denmark; Dominican Republic; Ecuador; Egypt; Estonia; Ethiopia; Finland; France; Georgia; Germany; Ghana; Greece; Hong Kong; Hungary; Iceland; India; Indonesia; Iran; Israel; Italy; Japan; Kazakhstan; Kenya; Kuwait; Kyrgyzstan; Latvia; Lebanon; Libya; Lithuania; Luxembourg; Macedonia; Malawi; Malaysia; Mexico; Moldova; Mongolia; Morocco; Nepal; Netherlands; New Zealand; Niger; Nigeria; Norway; Oman; Pakistan; Peru; Poland; Portugal; Puerto Rico; Qatar; Republic of Korea; Saudi Arabia; Serbia; Singapore; Slovakia; Slovenia; South African Republic; Sri Lanka; Sudan; Sweden; Switzerland; Taiwan; Tajikistan; Thailand; Tunisia; Turkey; Uganda; Ukraine; United Arab Emirates; United Kingdom; United States of America; Uzbekistan; Zambia.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Lazarus, Jeffrey) .

the author responsible for correspondence tasks has been Lazarus, Jeffrey.