A Global Survey of Physicians Knowledge About Nonalcoholic Fatty Liver Disease

Younossi, Zobair M.; Ong, Janus P.; Takahashi, Hirokazu; Yılmaz, Yusuf; Eguchi, Yuichiro; Kassas, Mohamed El; Buti, Marı́a; Diago, M.; Zheng, Ming‐Hua; Fan, Jian‐Gao; Yu, Ming‐Lung; Wong, Vincent Wai‐Sun; Alswat, Khalid; Chan, Wah‐Kheong; Méndez-Sánchez, Nahúm; Burra, Patrizia; Bugianesi, Elisabetta; Duseja, Ajay; George, Jacob; Papatheodoridis, George; Salehiniya, Hamid; Castéra, Laurent; Arrese, Marco; Kugelmas, Marcelo; Romero–Gómez, Manuel; Alqahtani, Saleh A.; Ziayee, Mariam; Lam, Brian; Younossi, Issah; Racila, Andrei; Henry, Linda; Stepanova, Maria

doi:10.1016/j.cgh.2021.06.048

Cited by 71 publications

(62 citation statements)

References 26 publications

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“…However, the effect of mild-to-moderate alcohol intake differs based on individual characteristics, including body weight, sex, and genetic polymorphisms in enzymes of alcohol metabolism [ 122 - 124 ]. In addition, patient understanding is the first step toward improving their lifestyle, and most patients are unable to understand the meaning of “non-alcoholic.” [ 34 ] Similarly, most non-specialist physicians lack awareness of the importance of fatty liver [ 35 ] and are unfamiliar with the difference between NAFLD and non-alcoholic steatohepatitis [ 125 ]. Furthermore, Muslims are widely distributed in the Asia-Pacific region, in particular West Asia.…”

Section: Mafld Improves Disease Awarenessmentioning

confidence: 99%

MAFLD enhances clinical practice for liver disease in the Asia-Pacific region

et al. 2022

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Fatty liver is now a major cause of liver disease in the Asia-Pacific region. Liver diseases in this region have distinctive characteristics. First, fatty liver is frequently observed in lean/normal-weight individuals. However, there is no standard definition of this unique phenotype. Second, fatty liver is often observed in patients with concomitant viral hepatitis. The exclusion of viral hepatitis from non-alcoholic fatty liver disease limits its value and detracts from the investigation and holistic management of coexisting fatty liver in patients with viral hepatitis. Third, fatty liver-associated hepatocellular carcinoma (HCC) is generally categorized as non-B non-C HCC. Fourth, the population is aging rapidly, and it is imperative to develop a practicable, low-intensity exercise program for elderly patients. Fifth, most patients and nonspecialized healthcare professionals still lack an awareness of the significance of fatty liver both in terms of intrahepatic and extrahepatic disease and cancer. Recently, an international expert panel proposed a new definition of fatty liver: metabolic dysfunction-associated fatty liver disease (MAFLD). One feature of MAFLD is that metabolic dysfunction is a prerequisite for diagnosis. Pertinent to regional issues, MAFLD also provides its diagnostic criteria in lean/normal-weight individuals. Furthermore, MAFLD is independent of any concomitant liver disease, including viral hepatitis. Therefore, MAFLD may be a more suitable definition for fatty liver in the Asia-Pacific region. In this review, we introduce the regional characteristics of fatty liver and discuss the advantages of MAFLD for improving clinical practice for liver disease in the region.

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Section: Mafld Improves Disease Awarenessmentioning

confidence: 99%

MAFLD enhances clinical practice for liver disease in the Asia-Pacific region

et al. 2022

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“…In that study, the extent of knowledge and approach to diagnostics and management varied considerably by provider type and experience managing patients with NAFLD. 13 Although significant knowledge gaps were reported among PCPs, and to a lesser extent endocrinologists, some findings (including variations in screening methods, liver biopsy, and approaches to evaluating alcohol consumption) indicated that education would be beneficial to all provider types studied. 13 Furthermore, the results of a needs assessment conducted by the AGA in 2020, composed of 751 physicians, including endocrinologists, gastroenterologists, hepatologists, and PCPs, demonstrated notable gaps in knowledge regarding screening and diagnosis of patients at risk for NAFLD/NASH, and treatment of patients with NAFLD/NASH.…”

Section: Discussionmentioning

confidence: 99%

Differences in NAFLD/NASH Management by Provider Specialty: Opportunities for Optimizing Multidisciplinary Care

Porayko¹,

Articolo²,

Cerenzia³

et al. 2022

JMDH

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Purpose Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are a part of a complex metabolic disease process requiring a multi-faceted and multidisciplinary management approach. This study was conducted to identify areas where medical education across a multidisciplinary team could be optimized in providing optimal care of patients with NAFLD/NASH. Methods A survey instrument including a patient case vignette was developed to understand approaches of US clinicians to diagnosis and management of patients with NAFLD/NASH. The survey was fielded via email in December 2020–January 2021. Analysis was conducted using embedded Qualtrics analytic software. Results There were 629 survey respondents: 318 PCPs, including physicians, NPs, and PAs, 57 hepatologists, 156 gastroenterologists, and 98 endocrinologists. Survey results demonstrated variation in likelihood to screen patients for NAFLD/NASH among specialists and PCPs as well as in the types of clinicians that respondents would involve in the initial management of a patient diagnosed with NASH. Notably, between 15% and 33% across respondent clinician types would not include any other clinicians or medical specialists in initial management. For a patient with newly diagnosed NASH, the most likely initial management recommendations included drug therapy to improve control of diabetes and therapy to lower lipids and were less likely to recommend drug therapy for weight loss, drug therapy for NASH, or bariatric surgery. Respondents rated “poor patient adherence to lifestyle modifications” and “lack of approved therapies for NASH” as the most significant barriers to optimal management of patients with NASH. Conclusion Variation in the evaluation and management of patients with NAFLD/NASH across PCPs and medical subspecialists was identified in this study. Education aimed at multidisciplinary roles in optimally managing patients with NAFLD/NASH, can be beneficial, particularly if focused on increasing screening, implementing guideline updates as they emerge, and incorporating new therapies as they gain approval for clinical practice.

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“…A recent global survey of physicians' knowledge about NAFLD found a significant knowledge gap for the identification, diagnosis, and management of NAFLD, especially among primary care providers who are often the first to see patients at risk for NAFLD. 42 To address this challenge, a Clinical Care Pathway has recently been developed by the American Gastroenterological Association to provide guidance on the screening, diagnosis, and treatment of NAFLD. 6 We found associations with known fatty liver disease risk factors, including age, non-Hispanic Asian race-ethnicity, BMI, waist-to-hip ratio, pre-diabetes and diabetes, total cholesterol, blood pressure, C-reactive protein and ALT, and inverse relationships with non-Hispanic black raceethnicity and HDL cholesterol.…”

Section: Discussionmentioning

confidence: 99%

“…A recent global survey of physicians’ knowledge about NAFLD found a significant knowledge gap for the identification, diagnosis, and management of NAFLD, especially among primary care providers who are often the first to see patients at risk for NAFLD. 42 To address this challenge, a Clinical Care Pathway has recently been developed by the American Gastroenterological Association to provide guidance on the screening, diagnosis, and treatment of NAFLD. 6…”

Section: Discussionmentioning

confidence: 99%

Prepandemic prevalence estimates of fatty liver disease and fibrosis defined by liver elastography in the United States

Ruhl

2022

Preprint

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Background & AimsFatty liver disease is a growing public health burden with serious consequences. We estimated prepandemic prevalence of fatty liver disease determined by transient elastography assessed hepatic steatosis and fibrosis, and examined associations with lifestyle and other factors in a United States population sample.MethodsLiver stiffness and controlled attenuation parameter (CAP) were assessed on 7,923 non-Hispanic white, non-Hispanic black, non-Hispanic Asian, and Hispanic men and women aged 20 years and over in the National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 prepandemic data.ResultsThe prevalence of fatty liver disease estimated by CAP >300 dB/m was 28.8% and of fibrosis (liver stiffness >8 kPa) was 10.4%. Only 7.2% of participants with fatty liver disease and 10.9% with fibrosis reported being told by a health care provider that they had liver disease. In addition to known risk factors such as metabolic factors and ALT, persons with fatty liver disease were less likely to meet physical activity guidelines, more likely to be sedentary for 12 or more hours a day, and reported a less healthy diet. Persons with fibrosis were less likely to have a college degree and reported a less healthy diet.ConclusionIn the U.S. population, most persons with fatty liver disease are unaware of their condition. Although physical activity and dietary modifications might reduce the fatty liver disease burden, the COVID pandemic has been less favorable for lifestyle changes. There is an urgent need for fatty liver disease management in high-risk individuals using transient elastography or other noninvasive methods to intervene in disease progression.

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A Global Survey of Physicians Knowledge About Nonalcoholic Fatty Liver Disease

Cited by 71 publications

References 26 publications

MAFLD enhances clinical practice for liver disease in the Asia-Pacific region

MAFLD enhances clinical practice for liver disease in the Asia-Pacific region

Differences in NAFLD/NASH Management by Provider Specialty: Opportunities for Optimizing Multidisciplinary Care

Prepandemic prevalence estimates of fatty liver disease and fibrosis defined by liver elastography in the United States

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