Browsing by Author "Allen, Alina M."

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    A global action agenda for turning the tide on fatty liver disease
    (2024) Lazarus, Jeffrey V.; Mark, Henry E.; Allen, Alina M.; Arab, Juan Pablo; Carrieri, Patrizia; Noureddin, Mazen; Alazawi, William; Alkhouri, Naim; Alqahtani, Saleh A.; Anstee, Quentin M.; Arrese, Marco; Bataller, Ramon; Berg, Thomas; Brennan, Paul N.; Burra, Patrizia; Castro-Narro, Graciela E.; Cortez-Pinto, Helena; Cusi, Kenneth; Dedes, Nikos; Duseja, Ajay; Francque, Sven M.; Gastaldelli, Amalia; Hagstrom, Hannes; Huang, Terry T. K.; Wajcman, Dana Ivancovsky; Kautz, Achim; Kopka, Christopher J.; Krag, Aleksander; Newsome, Philip N.; Rinella, Mary E.; Romero, Diana; Sarin, Shiv Kumar; Silva, Marcelo; Spearman, C. Wendy; Terrault, Norah A.; Tsochatzis, Emmanuel A.; Valenti, Luca; Villota-Rivas, Marcela; Zelber-Sagi, Shira; Schattenberg, Joern M.; Wong, Vincent Wai-Sun; Younossi, Zobair M.
    Background and Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care.Approach and Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over 2 rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities using Qualtrics XM, indicating agreement using a 4-point Likert-scale and providing written feedback. Priorities were revised between rounds, and in R2, panelists also ranked the priorities within 6 domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2, the mean percentage of "agree" responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% "agree"). The highest-ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance.Conclusions: This consensus-driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reduce fatty liver disease prevalence and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels.
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    A global research priority agenda to advance public health responses to fatty liver disease
    (2023) Lazarus, Jeffrey V.; Mark, Henry E.; Allen, Alina M.; Arab, Juan Pablo; Carrieri, Patrizia; Noureddin, Mazen; Alazawi, William; Alkhouri, Naim; Alqahtani, Saleh A.; Arrese, Marco; Bataller, Ramon; Berg, Thomas; Brennan, Paul N.; Burra, Patrizia; Castro-Narro, Graciela E.; Cortez-Pinto, Helena; Cusi, Kenneth; Dedes, Nikos; Duseja, Ajay; Francque, Sven M.; Hagstrom, Hannes; Huang, Terry T. -K.; Wajcman, Dana Ivancovsky; Kautz, Achim; Kopka, Christopher J.; Krag, Aleksander; Miller, Veronica; Newsome, Philip N.; Rinella, Mary E.; Romero, Diana; Sarin, Shiv Kumar; Silva, Marcelo; Spearman, C. Wendy; Tsochatzis, Emmanuel A.; Valenti, Luca; Villota-Rivas, Marcela; Zelber-Sagi, Shira; Schattenberg, Jorn M.; Wong, Vincent Wai-Sun; Younossi, Zobair M.
    Background & aims: 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.
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    Global survey of stigma among physicians and patients with nonalcoholic fatty liver disease
    (2024) Younossi, Zobair M.; Alqahtani, Saleh A.; Alswat, Khalid; Yilmaz, Yusuf; Keklikkiran, Caglayan; Funuyet-Salas, Jesus; Romero-Gomez, Manuel; Fan, Jian-Gao; Zheng, Ming-Hua; El-Kassas, Mohamed; Castera, Laurent; Liu, Chun-Jen; Wong, Vincent Wai-Sun; Zelber-Sagi, Shira; Allen, Alina M.; Lam, Brian; Treeprasertsuk, Sombat; Hameed, Saeed; Takahashi, Hirokazu; Kawaguchi, Takumi; Schattenberg, Joern M.; Duseja, Ajay; Newsome, Phil N.; Francque, Sven; Spearman, C. Wendy; Fernandez, Marlen I. Castellanos; Burra, Patrizia; Roberts, Stuart K.; Chan, Wah-Kheong; Arrese, Marco; Silva, Marcelo; Rinella, Mary; Singal, Ashwani K.; Gordon, Stuart; Fuchs, Michael; Alkhouri, Naim; Cusi, Kenneth; Loomba, Rohit; Ranagan, Jane; Eskridge, Wayne; Kautz, Achim; Ong, Janus P.; Kugelmas, Marcelo; Eguchi, Yuichiro; Diago, Moises; Yu, Ming-Lung; Gerber, Lynn; Fornaresio, Lisa; Nader, Fatema; Henry, Linda; Racila, Andrei; Golabi, Pegah; Stepanova, Maria; Carrieri, Patrizia; Lazarus, Jeffrey, V
    Background & Aims: Patients with fatty liver disease may experience stigma from the disease or comorbidities. In this cross-sectional study, we aimed to understand stigma among patients with nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) and healthcare providers. Methods: Members of the Global NASH Council created two surveys about experiences/attitudes toward NAFLD and related diagnostic terms: a 68-item patient and a 41-item provider survey. Results: Surveys were completed by 1,976 patients with NAFLD across 23 countries (51% Middle East/North Africa [MENA], 19% Europe, 17% USA, 8% Southeast Asia, 5% South Asia) and 825 healthcare providers (67% gastroenterologists/hepatologists) across 25 countries (39% MENA, 28% Southeast Asia, 22% USA, 6% South Asia, 3% Europe). Of all patients, 48% ever disclosed having NAFLD/NASH to family/friends; the most commonly used term was "fatty liver" (88% at least sometimes); "metabolic disease" or "MAFLD" were rarely used (never by >84%). Regarding various perceptions of diagnostic terms by patients, there were no substantial differences between "NAFLD", "fatty liver disease (FLD)", "NASH", or "MAFLD". The most popular response was being neither comfortable nor uncomfortable with either term (56%-71%), with slightly greater discomfort with "FLD" among the US and South Asian patients (47-52% uncomfortable). Although 26% of patients reported stigma related to overweight/obesity, only 8% reported a history of stigmatization or discrimination due to NAFLD. Among providers, 38% believed that the term "fatty" was stigmatizing, while 34% believed that "nonalcoholic" was stigmatizing, more commonly in MENA (43%); 42% providers (gastroenterologists/hepatologists 45% vs. 37% other specialties, p = 0.03) believed that the name change to metabolic dysfunction-associated steatotic liver disease (or MASLD) might reduce stigma. Regarding the new nomenclature, the percentage of providers reporting "steatotic liver disease" as stigmatizing was low (14%). Conclusions: The perception of NAFLD stigma varies among patients, providers, geographic locations and sub-specialties. (c) 2023 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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    Implementation of a liver health check in people with type 2 diabetes
    (2024) Abeysekera, Kushala W. M.; Valenti, Luca; Younossi, Zobair; Dillon, John F.; Allen, Alina M.; Noureddin, Mazen; Rinella, Mary E.; Tacke, Frank; Francque, Sven; Gines, Pere; Thiele, Maja; Newsome, Philip N.; Guha, Indra Neil; Eslam, Mohammed; Schattenberg, Joern M.; Alqahtani, Saleh A.; Arrese, Marco; Berzigotti, Annalisa; Holleboom, Adriaan G.; Caussy, Cyrielle; Cusi, Kenneth; Roden, Michael; Hagstroem, Hannes; Wong, Vincent Wai-Sun; Mallet, Vincent; Castera, Laurent; Lazarus, Jeffrey V.; Tsochatzis, Emmanuel A.
    As morbidity and mortality related to potentially preventable liver diseases are on the rise globally, early detection of liver fibrosis offers a window of opportunity to prevent disease progression. Early detection of non-alcoholic fatty liver disease allows for initiation and reinforcement of guidance on bodyweight management, risk stratification for advanced liver fibrosis, and treatment optimisation of diabetes and other metabolic complications. Identification of alcohol-related liver disease provides the opportunity to support patients with detoxification and abstinence programmes. In all patient groups, identification of cirrhosis ensures that patients are enrolled in surveillance programmes for hepatocellular carcinoma and portal hypertension. When considering early detection strategies, success can be achieved from applying ad-hoc screening for liver fibrosis in established frameworks of care. Patients with type 2 diabetes are an important group to consider case findings of advanced liver fibrosis and cirrhosis, as up to 19% have advanced fibrosis (which is ten times higher than the general population) and almost 70% have non-alcoholic fatty liver disease. Additionally, patients with type 2 diabetes with alcohol use disorders have the highest proportion of liver-related morbidity of people with type 2 diabetes generally. Patients with type 2 diabetes receive an annual diabetes review as part of their routine clinical care, in which the health of many organs are considered. Yet, liver health is seldom included in this review. This Viewpoint argues that augmenting the existing risk stratification strategy with an additional liver health check provides the opportunity to detect advanced liver fibrosis, thereby opening a window for early interventions to prevent end-stage liver disease and its complications, including hepatocellular carcinoma
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    MASLD: a disease in flux
    (2024) Allen, Alina M.; Arab, Juan Pablo; Wong, Vincent Wai-Sun
    To coincide with the 20th anniversary of Nature Reviews Gastroenterology & Hepatology, we asked three experts to reflect on the past, present and future of metabolic dysfunction-associated steatotic liver disease (MASLD) research and clinical management. They comment on how MASLD research and clinical management has changed over the past 20 years, the strengths and limitations of the MASLD field today, and their predictions for progress over the next 20 years.
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    Real-world evidence on non-invasive tests and associated cut-offs used to assess fibrosis in routine clinical practice
    (2023) Lazarus, Jeffrey, V; Castera, Laurent; Mark, Henry E.; Allen, Alina M.; Adams, Leon A.; Anstee, Quentin M.; Arrese, Marco; Alqahtani, Saleh A.; Bugianesi, Elisabetta; Colombo, Massimo; Cusi, Kenneth; Hagstrom, Hannes; Loomba, Rohit; Romero-Gomez, Manuel; Schattenberg, Jorn M.; Thiele, Maja; Valenti, Luca; Wong, Vincent Wai-Sun; Yilmaz, Yusuf; Younossi, Zobair M.; Francque, Sven M.; Tsochatzis, Emmanuel A.
    Background & Aims: Non-invasive tests (NITs) offer a practical solution for advanced fibrosis identification in non-alcoholic fatty liver disease (NAFLD). Despite increasing implementation, their use is not standardised, which can lead to inconsistent interpretation and risk stratification. We aimed to assess the types of NITs and the corresponding cut-offs used in a range of healthcare settings. Methods: A survey was distributed to a convenience sample of liver health experts who participated in a global NAFLD consensus statement. Respondents provided information on the NITs used in their clinic with the corresponding cut-offs and those used in established care pathways in their areas.Results: There were 35 respondents from 24 countries, 89% of whom practised in tertiary level settings. A total of 14 different NITs were used, and each respondent reported using at least one (median = 3). Of the respondents, 80% reported using FIB-4 and liver stiffness by vibration-controlled transient elastography (Fibroscan & REG;), followed by the NAFLD fibrosis score (49%). For FIB-4, 71% of respondents used a low cut-off of <1.3 (range <1.0 to <1.45) and 21% reported using age-specific cut-offs. For Fibroscan & REG;, 21% of respondents used a single liver stiffness cut-off: 8 kPa in 50%, while the rest used 7.2 kPa, 7.8 kPa and 8.7 kPa. Among the 63% of respondents who used lower and upper liver stiffness cut-offs, there were variations in both values (<5 to <10 kPa and >7.5 to >20 kPa, respectively).Conclusions: The cut-offs used for the same NITs for NAFLD risk stratification vary between clinicians. As cut-offs impact test performance, these findings underscore the heterogeneity in risk-assessment and support the importance of establishing consistent guidelines on the standardised use of NITs in NAFLD management. Lay summary: Owing to the high prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population it is important to identify those who have more advanced stages of liver fibrosis, so that they can be properly treated. Non-invasive tests (NITs) provide a practical way to assess fibrosis risk in patients. However, we found that the cut-offs used for the same NITs vary between clinicians. As cut-offs impact test performance, these findings highlight the importance of establishing consistent guidelines on the standardised use of NITs to optimise clinical management of NAFLD.& COPY; 2022 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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    The impact of stigma on quality of life and liver disease burden among patients with nonalcoholic fatty liver disease
    (2024) Younossi, Zobair M.; AlQahtani, Saleh A.; Funuyet-Salas, Jesus; Romero-Gomez, Manuel; Yilmaz, Yusuf; Keklikkiran, Caglayan; Alswat, Khalid; Yu, Ming-Lung; Liu, Chun-Jen; Fan, Jian-Gao; Zheng, Ming-Hua; Burra, Patrizia; Francque, Sven M.; Castera, Laurent; Schattenberg, Joern M.; Newsome, Philip N.; Allen, Alina M.; El-Kassas, Mohamed; Treeprasertsuk, Sombat; Hameed, Saeed; Wong, Vincent Wai-Sun; Zelber-Sagi, Shira; Takahashi, Hirokazu; Kawaguchi, Takumi; Fernandez, Marlen I. Castellanos; Duseja, Ajay; Arrese, Marco; Rinella, Mary; Singal, Ashwani K.; Gordon, Stuart C.; Fuchs, Michael; Eskridge, Wayne; Alkhouri, Naim; Cusi, Kenneth; Loomba, Rohit; Ranagan, Jane; Kautz, Achim; Ong, Janus P.; Kugelmas, Marcelo; Eguchi, Yuichiro; Diago, Moises; Gerber, Lynn; Lam, Brian; Fornaresio, Lisa; Nader, Fatema; Spearman, C. Wendy; Roberts, Stuart K.; Chan, Wah-Kheong; Silva, Marcelo; Racila, Andrei; Golabi, Pegah; Ananchuensook, Prooksa; Henry, Linda; Stepanova, Maria; Carrieri, Patrizia; Lazarus, Jeffrey, V
    Background & Aims: Patients with nonalcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) face a multifaceted disease burden which includes impaired health-related quality of life (HRQL) and potential stigmatization. We aimed to assess the burden of liver disease in patients with NAFLD and the relationship between experience of stigma and HRQL. Methods: Members of the Global NASH Council created a survey about disease burden in NAFLD. Participants completed a 35-item questionnaire to assess liver disease burden (LDB) (seven domains), the 36-item CLDQ-NASH (six domains) survey to assess HRQL and reported their experience with stigmatization and discrimination. Results: A total of 2,117 patients with NAFLD from 24 countries completed the LDB survey (48% Middle East and North Africa, 18% Europe, 16% USA, 18% Asia) and 778 competed CLDQ-NASH. Of the study group, 9% reported stigma due to NAFLD and 26% due to obesity. Participants who reported stigmatization due to NAFLD had substantially lower CLDQ-NASH scores (all p <0.0001). In multivariate analyses, experience with stigmatization or discrimination due to NAFLD was the strongest independent predictor of lower HRQL scores (beta from -5% to -8% of score range size, p <0.02). Experience with stigmatization due to obesity was associated with lower Activity, Emotional Health, Fatigue, and Worry domain scores, and being uncomfortable with the term "fatty liver disease" with lower Emotional Health scores (all p <0.05). In addition to stigma, the greatest disease burden as assessed by LDB was related to patients' self-blame for their liver disease. Conclusions: Stigmatization of patients with NAFLD, whether it is caused by obesity or NAFLD, is strongly and independently associated with a substantial impairment of their HRQL. Self-blame is an important part of disease burden among patients with NAFLD. Impact and implications: Patients with nonalcoholic fatty liver disease (NAFLD), recently renamed metabolic dysfunction-associated steatotic liver disease (MASLD), may experience impaired health-related quality of life and stigmatization. Using a specifically designed survey, we found that stigmatization of patients with NAFLD, whether it is caused by obesity or the liver disease per se, is strongly and independently associated with a substantial impairment of their quality of life. Physicians treating patients with NAFLD should be aware of the profound implications of stigma, the high prevalence of self-blame in the context of this disease burden, and that providers' perception may not adequately reflect patients' perspective and experience with the disease. (c) 2024 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).