Non-alcoholic fatty liver disease: a survey of involvement of primary care physicians

Mari, Amir; Omari, Sohaib; Baker, Fadi Abu; Much, Saif Abu; Ahmad, Helal Said; Khoury, Tawfik; Nseir, William; Mahamid, Mahmud

doi:10.23736/s1121-421x.19.02618-7

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…Developing and implementing these pathways will require coordination and cooperation among health care organizations and policymakers. 82 Although specialties like endocrinology and cardiology are beginning to acknowledge the importance of MASLD, the current guidelines and recommendations for managing MASLD show a limited emphasis on primary care. 83 Improving the quality of patient care is a multifaceted concept that requires consideration of medical, contextual, and policy factors.…”

Section: Models Of Care For Metabolic Dysfunction-associated Steatoti...mentioning

confidence: 99%

Tailored Model of Care for Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease

El-Kassas,

Awad,

Elbadry

et al. 2024

Semin Liver Dis

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Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is increasing globally, creating a growing public health concern. However, this disease is often not diagnosed, and accurate data on its epidemiology are limited in many geographical regions, making it challenging to provide proper care and implement effective national plans. To combat the increasing disease burden, screening and diagnosis must reach a significant number of high-risk subjects. Addressing MASLD as a healthcare challenge requires a multidisciplinary approach involving prevention, diagnosis, treatment, and care, with collaboration between multiple stakeholders in the healthcare system. This approach must be guided by national and global strategies, to be combined with efficient models of care developed through a bottom-up process. This review article highlights the pillars of the MASLD model of care, including screening, risk stratification, and establishing a clinical care pathway for management, in addition to discussing the impact of nomenclature change on the proposed model of care.

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Section: Models Of Care For Metabolic Dysfunction-associated Steatoti...mentioning

confidence: 99%

Tailored Model of Care for Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease

El-Kassas,

Awad,

Elbadry

et al. 2024

Semin Liver Dis

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“…9 Nevertheless, involving primary care in NAFLD management faces several challenges, which include: how to go about transforming primary care physicians into prevention stakeholders and incentivising them for their novel role; figuring out which diagnostic tools and training to support lifestyle changes; and how to build clinical care pathways, especially for the most severely affected patients. 10 There is currently a lack of focus on primary care in NAFLD management guidelines and recommendations, though other specialties such as endocrinology and cardiology are starting to recognise the significance of NAFLD. 11 We conducted this review to shed light on previous challenges around this and to provide recommendations for building the most effective primary care-based models and clinical pathways for patients with NAFLD (Box 1).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, involving primary care in NAFLD management faces several challenges, which include: how to go about transforming primary care physicians into prevention stakeholders and incentivising them for their novel role; figuring out which diagnostic tools and training to support lifestyle changes; and how to build clinical care pathways, especially for the most severely affected patients 10 …”

Section: Introductionmentioning

confidence: 99%

Management of NAFLD in primary care settings

Wong

Zelber‐Sagi

Cusi

et al. 2022

Liver International

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Non-alcoholic fatty liver disease (NAFLD) affects at least 25% of the general population and is an increasingly important cause of cirrhosis and hepatocellular carcinoma.Although it is the research focus of the hepatology field, it is clear that primary care physicians are seeing the majority of NAFLD patients and are in a pivotal position to provide quality care. In this article, we review the role of primary care in the management of NAFLD. NAFLD is common in patients with diabetes, obesity and other metabolic risk factors. Abdominal ultrasonography is the most commonly used method to diagnose fatty liver. Simple fibrosis scores have high negative predictive values in excluding advanced liver fibrosis and future liver-related events and can be used in primary care as initial evaluation. An abnormal result should be followed by subsequent workup or specialist referral. Primary care is the ideal setting to institute multidisciplinary care, especially the involvement of dietitians and physical activity trainers in lifestyle intervention, as well as initiating the discussion of bariatric surgery in patients with severe obesity. Although specific drug treatment for steatohepatitis would require a more precise diagnosis, metabolic drugs that improve both steatohepatitis and cardiovascular outcomes (e.g. glucagon-like peptide-1 receptor agonists) may be considered in patients with NAFLD.

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confidence: 99%

“…(12) Furthermore, in a survey conducted among PCPs, 85% underestimated the prevalence of NAFLD, (13) while at the same time, 78% of PCPs did not consider themselves well prepared to manage patients with NAFLD/NASH. (14) The paradox of NAFLD as a highly prevalent disease with only a small proportion progressing to severe disease has led to NAFLD currently being one of the most challenging public health problems worldwide.…”

mentioning

confidence: 99%

Nonalcoholic Fatty Liver Disease Screening in Type 2 Diabetes Mellitus Patients in the Primary Care Setting

Barbosa

Lai

2021

Hepatology Communications

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Nonalcoholic fatty liver disease (NAFLD) is a major public health problem worldwide and the most common chronic liver disease. NAFLD currently affects approximately one in every four people in the United States, and its global burden is expected to rise in the next decades. Despite being a prevalent disease in the general population, only a minority of patients with NAFLD will develop nonalcoholic steatohepatitis (NASH) with advanced liver fibrosis (stage 3‐4 fibrosis) and liver‐related complications. Certain populations, such as patients with type 2 diabetes mellitus (T2DM), are recognized to be at the highest risk for developing NASH and advanced fibrosis. Both the American Diabetes Association and the European Association for the Study of Diabetes recommend screening of all T2DM for NAFLD. Incorporating a simple noninvasive algorithm into the existing diabetic care checklists in the primary care practice or diabetologist’s office would efficiently identify patients at high risk who should be referred to specialists. The proposed algorithm involves a first‐step annual fibrosis‐4 score (FIB‐4) followed by vibration‐controlled transient elastography (VCTE) for those with indeterminate or high‐risk score (FIB‐4 ≥1.3). Patients at low‐risk (FIB‐4 <1.3 or VCTE <8 kPa) can be followed up by primary care providers for lifestyle changes and yearly calculation of FIB‐4, while patients at high risk (FIB‐4 ≥1.3 and VCTE ≥8 kPa) should be referred to a liver‐specialized center. Conclusion: Patients with T2DM or prediabetes should be screened for NASH and advanced fibrosis. The proposed simple algorithm can be easily incorporated into the existing workflow in the primary care or diabetology clinic to identify patients at high risk for NASH and advanced fibrosis who should be referred to liver specialists.

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Non-alcoholic fatty liver disease: a survey of involvement of primary care physicians

Cited by 7 publications

References 14 publications

Tailored Model of Care for Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease

Tailored Model of Care for Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease

Management of NAFLD in primary care settings

Nonalcoholic Fatty Liver Disease Screening in Type 2 Diabetes Mellitus Patients in the Primary Care Setting

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