Physicians' Perceptions and Practices on Metabolic Dysfunction-Associated Liver Disease: An Exploratory Survey

Abstract

Background

There has been a rapid increase in the incidence and prevalence of metabolic dysfunction-associated liver disease (MASLD) in the Middle East and Africa (MEA) regions.

Methods

We aimed to assess the knowledge and awareness of MASLD among MEA physicians and evaluate their current approach to diagnosing, managing, and referring to MASLD. We used an online survey through a validated questionnaire and a convenience sample of MEA clinicians to examine knowledge, practices, and attitudes regarding MASLD and the barriers to providing care for this condition.

Results

A total of 128 clinicians completed the survey. Most were from the Arabian Gulf and the Middle East (72.6%). Most were senior adult endocrinologists; 53.2% of respondents considered the prevalence of MASLD in the general population around 10% or 30%; 28.6% of respondents felt that liver enzymes were sufficiently sensitive to detect underlying MASLD. Most respondents were unsure whether the Enhanced Liver Fibrosis score or Fibrosis 4 score could help to identify those with high risk for advanced fibrosis or cirrhosis (54.5 and 29.1%, respectively, were unsure). Although 83.8% of respondents would refer a patient to a gastroenterologist if they suspect the patient has MASLD, 29.4% do not make referrals. Of concern, 64.5% of participants would unlikely refer a patient to a hepatologist unless liver function tests are abnormal. Respondents identified several barriers to making referrals.

Conclusion

Most respondents viewed MASLD as a significant health concern. However, the rates of screening for MASLD were low. A key obstacle in managing these patients was the lack of knowledge regarding MASLD. Regional guidelines and continuing professional development activities should focus on strategies for screening at-risk patients, and evidence-based management practices.

Keywords

metabolic dysfunction-associated liver disease (MASLD) - nonalcoholic steatohepatitis (NASH) - elastography - Enhanced Liver Fibrosis (ELF) - Fibrosis 4 (FIB 4) - Middle East and Africa - physicians perceptions

Availability of Data, had access to the data

The data sets used during the current study are available from the corresponding author upon reasonable request.

Authors' Contributions

S.A.B. was involved in data collection, analysis, writing, and research. All authors read and approved the final manuscript.

Compliance with Ethical Principles

The ethics review committee of the Sheikh Khalifa Medical City, Abu Dhabi, UAE, gave ethical approval. Participants gave electronic consent before they could proceed to the survey questionnaire.

Publikationsverlauf

Artikel online veröffentlicht:
28. Februar 2025

• References

• 1 Brunt EM, Wong VW, Nobili V. et al. Nonalcoholic fatty liver disease. Nat Rev Dis Primers 2015; 1: 15080
• 2 Armstrong MJ, Houlihan DD, Bentham L. et al. Presence and severity of non-alcoholic fatty liver disease in a large prospective primary care cohort. J Hepatol 2012; 56 (01) 234-240
• 3 Hagström H, Shang Y, Hegmar H, Nasr P. Natural history and progression of metabolic dysfunction-associated steatotic liver disease. Lancet Gastroenterol Hepatol 2024; 9 (10) 944-956
• 4 Amini-Salehi E, Letafatkar N, Norouzi N. et al. Global prevalence of nonalcoholic fatty liver disease: an updated review meta-analysis comprising a population of 78 million from 38 countries. Arch Med Res 2024; 55 (06) 103043
• 5 Golabi P, Paik JM, AlQahtani S, Younossi Y, Tuncer G, Younossi ZM. Burden of non-alcoholic fatty liver disease in Asia, the Middle East and North Africa: data from Global Burden of Disease 2009-2019. J Hepatol 2021; 75 (04) 795-809
• 6 Ong J, Alswat K, Hamid S, El-Kassas M. Nonalcoholic fatty liver disease in Asia, Africa, and Middle East region. Clin Liver Dis 2023; 27 (02) 287-299
• 7 Sanai FM, Abaalkhail F, Hasan F, Farooqi MH, Nahdi NA, Younossi ZM. Management of nonalcoholic fatty liver disease in the Middle East. World J Gastroenterol 2020; 26 (25) 3528-3541
• 8 Dyson JK, Anstee QM, McPherson S. Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging. Frontline Gastroenterol 2014; 5 (03) 211-218
• 9 Grattagliano I, D'Ambrosio G, Palmieri VO, Moschetta A, Palasciano G, Portincasa P. “Steatostop Project” Group. Improving nonalcoholic fatty liver disease management by general practitioners: a critical evaluation and impact of an educational training program. J Gastrointestin Liver Dis 2008; 17 (04) 389-394
• 10 Keam SJ. Resmetirom: first approval. Drugs 2024; 84 (06) 729-735
• 11 Patel PJ, Banh X, Horsfall LU. et al. Underappreciation of non-alcoholic fatty liver disease by primary care clinicians: limited awareness of surrogate markers of fibrosis. Intern Med J 2018; 48 (02) 144-151
• 12 Said A, Gagovic V, Malecki K, Givens ML, Nieto FJ. Primary care practitioners survey of non-alcoholic fatty liver disease. Ann Hepatol 2013; 12 (05) 758-765
• 13 Matthias AT, Fernandopulle ANR, Seneviratne SL. Survey on knowledge of non-alcoholic fatty liver disease (NAFLD) among doctors in Sri Lanka: a multicenter study. BMC Res Notes 2018; 11 (01) 556
• 14 European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Diabetologia 2016; 59 (06) 1121-1140
• 15 Cusi K, Isaacs S, Barb D. et al. American Association of Clinical Endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: co-sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract 2022; 28 (05) 528-562
• 16 European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol 2024; 81 (03) 492-542
• 17 Halamy Pereira L, Barros F, Andrade TG, Oliveira Neto AA, Nogueira CAV, Valezi AC. Metabolic dysfunction-associated steatotic liver disease - assessment of patients with obesity and metabolic syndrome - guideline from the Brazilian Society of Bariatric And Metabolic Surgery. Arq Bras Cir Dig 2024; 37: e1821
• 18 Beshyah SA, Sherif IH, Mustafa HE. et al. Patterns of clinical management of hypothyroidism in adults: an electronic survey of physicians from the Middle East and Africa. J Diabetes Endocr Pract 2021; 4: 75-82
• 19 Beshyah SA, Ali KF. Management of adrenal insufficiency: a survey of perceptions and practices of physicians from the Middle East and North Africa. J Diabetes Endocr Pract 2021; 4: 125-130
• 20 Beshyah SA, Bashir M, Hafidh K. et al. Impact of patient age on management of hypothyroidism: a survey of physicians from three developing regions. J Diabetes Endocr Pract 2024; 7 (03) 135-144
• 21 Khalil AB, Beshyah SA, Abdella N. et al. Diabesity in the Arabian Gulf: challenges and opportunities. Oman Med J 2018; 33 (04) 273-282