Global Metabolic & Liver Health Policy

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

Lazarus, J. V., Mark, H. E., Allen, A. M., Arab, J. P., Carrieri, P., Noureddin, M., Alazawi, W., Alkhouri, N., Alqahtani, S. A., Arrese, M., Bataller, R., Berg, T., Brennan, P. N., Burra, P., Castro-Narro, G. E., Cortez-Pinto, H., Cusi, K., Dedes, N., Duseja, A., Francque, S. M., Hagström, H., Huang, T. T.-K., Ivancovsky Wajcman, D., Kautz, A., Kopka, C. J., Krag, A., Miller, V., Newsome, P. N., Rinella, M. E., Romero, D., Sarin, S. K., Silva, M., Spearman, C. W., Tsochatzis, E. A., Valenti, L., Villota-Rivas, M., Zelber-Sagi, S., Schattenberg, J. M., Wong, V. W.-S., & Younossi, Z. M. on behalf of the Healthy Livers, Healthy Lives Collaborators

Journal of Hepatology, Volume 79, Issue 3, 618 - 634

Around 4 in 10 adults and 1 in 10 children and teenagers across the world have metabolic associated-dysfunction steatotic liver disease (MASLD), a condition where fat is being stored in the liver due to metabolic issues, like type 2 diabetes. MASLD is the most common liver disease worldwide, being the main cause of liver cancer, along with many other cancers.

Even though science has come a long way in understanding liver health, the number of people with this condition keeps going up. That is why there is an urgent need to learn more about how to prevent, treat, and manage MASLD. To guide this effort, experts from around the world collaborated and identified 28 key research areas. These include learning more about the prevalence (amount of people with the disease), how to enhance treatment and care, how to raise awareness, and how health policies can be strengthened.

Notably, this research was done before the term MASLD became widely used. At the time, the condition was still called “fatty liver disease” and was used in the paper, even though we now use the newer, less stigmatizing name.

A group of nine co-chairs initially drafted a set of research priorities, which were then reviewed and refined by 40 core experts.

Following this, a larger international panel of specialists participated in two rounds of online surveys (344 in Round 1 and 288 in Round 2), using the Delphi method, a structured approach to building expert consensus. Participants rated each proposed priority and provided written feedback, which was used to revise and improve the list between rounds.

In the second round, panelists also ranked the priorities within six defined domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy.

The main outcome of this work is a list of 28 research priorities that experts strongly agreed upon (over 90% agreement).

These included:

  • developing better non-invasive tests (blood sample tests or image based tests) for diagnosing and monitoring the disease
  • validating care models for children, using digital tools and artificial intelligence in healthcare, and
  • understanding patients’ experiences and challenges, including the stigma they face.

The study also highlighted the importance of assessing how existing health policies address (or fail to address) MASLD and where improvement could take place.

This global research agenda provides a clear, shared direction for future research and policy-making in the field of MASLD. It has the potential to greatly improve early diagnosis, treatment options, and the readiness of healthcare systems, especially in underserved regions. By emphasising education, patient engagement, and the innovative use of technology, the study could help mitigate the disease’s impact and promote more equitable and effective public health responses worldwide.

Author Contact Information

Jeffery V. Lazarus

Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA

jeffrey.lazarus@isglobal.org

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