A Sustainable Development Goal framework to guide multisectoral action on NAFLD through a societal approach

Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent condition that requires a comprehensive and coordinated response across sectors and disciplines. In the absence of a multisectoral framework, we developed a NAFLD Sustainable Development Goals (SDG) framework to converge thinking about the design and delivery of NAFLD public health responses. A multidisciplinary group identified SDG targets and indicators for inclusion in the NAFLD SDG framework through a two stage process. Firstly, a core team of three researchers independently reviewed the 169 SDG targets and 231 unique indicators proposed by the Inter Agency and Expert Group on SDG to select a shortlist. Over two Delphi rounds, a multidisciplinary group of 12 experts selected which of the shortlisted targets and indicators to include in the NAFLD SDG framework. Respondents also provided written feedback on their selection. Targets and indicators with 75% or greater agreement were included in the final NAFLD SDG framework. The final framework comprises 16 targets, representing 9% of all SDG targets and 62% (16/26) of the shortlisted targets, and seven indicators, accounting for 50% (7/14) of the shortlisted indicators and 3% of all SDG indicators. The selected targets and indicators cover a broad range of factors, from health, food and nutrition to education, the economy and the built environment. Addressing the challenge of NAFLD will require reenvisioning the liver health landscape, with a greater focus on joined-up systems thinking and action. The NAFLD SDG framework can help guide this process, including by outlining the key stakeholders with whom the liver health community needs to engage.