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

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. Methods 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. Results 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 90% combined agreement. Conclusions 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. Impact and implications 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

Consumer understanding, interpretation and perceived levels of personal responsibility in relation to satiety-related claims

The aim of this study was to explore (a) whether and how consumers may (over-) interpret satiety claims, and (b) whether and to what extent consumers recognize that personal efforts are required to realize possible satiety-related or weight loss benefits. Following means-end chain theory, we explored for a number of satiety claims the extent of inference-making to higher-level benefits than actually stated in the claim, using internet-based questions and tasks. Respondents (N = 1504) in U.K., France, Italy and Germany participated in the study. The majority of these respondents correctly interpret satiety-related claims; i.e. they largely limit their interpretation to what was actually stated. They do not expect a “magic bullet” effect, but understand that personal efforts are required to translate product attributes into potential weight control benefits. Less-restrained eaters were at lower risk for over-interpreting satiety-related claims, whilst respondents with a stronger belief that their weight is something that they can control accept more personal responsibility, and better understand that personal efforts are required to be effective in weight control. Overall, these results indicate there is likely to be a relatively low level of consumer misinterpretation of satiety-related claims on food products

Consumer understanding, interpretation and perceived levels of personal responsibility in relation to satiety-related claims

The aim of this study was to explore (a) whether and how consumers may (over-) interpret satiety claims, and (b) whether and to what extent consumers recognize that personal efforts are required to realize possible satiety-related or weight loss benefits. Following means-end chain theory, we explored for a number of satiety claims the extent of inference-making to higher-level benefits than actually stated in the claim, using internet-based questions and tasks. Respondents (N = 1504) in U.K., France, Italy and Germany participated in the study. The majority of these respondents correctly interpret satiety-related claims; i.e. they largely limit their interpretation to what was actually stated. They do not expect a “magic bullet” effect, but understand that personal efforts are required to translate product attributes into potential weight control benefits. Less-restrained eaters were at lower risk for over-interpreting satiety-related claims, whilst respondents with a stronger belief that their weight is something that they can control accept more personal responsibility, and better understand that personal efforts are required to be effective in weight control. Overall, these results indicate there is likely to be a relatively low level of consumer misinterpretation of satiety-related claims on food products

Prevalence of lung tumors in patients with esophageal squamous cell carcinoma and vice versa: a systematic review and meta-analysis

Purpose : Recent reports suggest an increased prevalence of lung second primary tumors (LSPTs) in esophageal squamous cell carcinoma (ESCC) patients and vice versa. However, the exact prevalence of SPTs remains unclear and screening for these SPTs is currently not routinely performed in western countries. We aimed to report on the prevalence of LSPTs in patients with ESCC and esophageal second primary tumors (ESPTs) in patients with lung cancer (LC). Methods : Databases were searched until 25 March 2021 for studies reporting the prevalence of LSPTs in ESCC or vice versa. Pooled prevalences with 95% confidence intervals (CI) of SPTs were calculated with inverse variance, random-effects models and Clopper–Pearson. Results : Nineteen studies in ESCC patients and 20 studies in LC patients were included. The pooled prevalence of LSPTs in patients with ESCC was 1.8% (95% CI 1.4–2.3%). For ESPTs in LC patients, the pooled prevalence was 0.2% (95% CI 0.1–0.4%). The prevalence of LSPTs in ESCC patients was significantly higher in patients treated curatively compared to studies also including palliative patients (median 2.5% versus 1.3%). This difference was consistent for the ESPT prevalence in LC patients (treated curatively median 1.3% versus 0.1% for all treatments). Over 50% of the detected SPTs were squamous cell carcinomas and were diagnosed metachronously. Conclusion : Patients with ESCC and LC have an increased risk of developing SPTs in the lungs and esophagus. However, the relatively low SPT prevalence rates do not justify screening in these patients. Further research should focus on risk stratification to identify subgroups of patients at highest risk of SPT development