Practice Recommendations for the Management of MASLD in Primary Care: Consensus Results
Abstract
:1. Introduction
2. Materials and Methods
2.1. Composition of Expert Panel
2.2. Consensus Process
3. Results
3.1. First Round Results
3.2. Consensus Meeting and Round Two Rankings
- (A)
- Risk Screening and Diagnosis
- (B)
- Referral to Specialists
- (C)
- Management of MSALD–Lifestyle Interventions and Risk Factor Management
- (D)
- Pharmacological Treatment for MASLD/MASH
- (E)
- Pharmacological Treatment For Co-morbidity
- (F)
- Surgical Management
- (G)
- Integrated Care
- (A)
- Risk Screening and Diagnosis
- (B)
- Referral to specialists
- (C)
- Management of MSALD–Lifestyle Interventions and Risk Factor Modification
- (D)
- Pharmacological Treatment for MASLD/MASH
- (E)
- Pharmacological Treatment For Co-morbidity
- (F)
- Surgical Management
- (G)
- Integrated Care
4. Discussion
4.1. Summary
4.2. Impact
4.3. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Karlsen, T.H.; Sheron, N.; Zelber-Sagi, S.; Carrieri, P.; Dusheiko, G.; Bugianesi, E.; Pryke, R.; Hutchinson, S.J.; Sangro, B.; Martin, N.K.; et al. The EASL-lancet liver commission: Protecting the next generation of Europeans against liver disease complications and premature mortality. Lancet 2021, 399, 61–116. [Google Scholar] [CrossRef] [PubMed]
- Rinella, M.E.; Lazarus, J.V.; Ratziu, V.; Francque, S.M.; Sanyal, A.J.; Kanwal, F.; Romero, D.; Abdelmalek, M.F.; Anstee, Q.M.; Arab, J.P.; et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2023, 78, 1966–1986. [Google Scholar] [CrossRef]
- 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 nonalcoholic fatty liver disease. J. Hepatol. 2016, 9, 65–90. [Google Scholar] [CrossRef]
- Ofosu, A.; Ramai, D.; Reddy, M. Non-alcoholic fatty liver disease: Controlling an emerging epidemic, challenges, and future directions. Ann. Gastroenterol. 2018, 31, 288–295. [Google Scholar] [CrossRef]
- Mokdad, A.A.; Lopez, A.D.; Shahraz, S.; Lozano, R.; Mokdad, A.H.; Stanaway, J.; Murray, C.J.; Naghavi, M. Liver cirrhosis mortality in 187 countries between 1980 and 2010: A systematic analysis. BMC Med. 2014, 12, 145. [Google Scholar] [CrossRef] [PubMed]
- Marcellin, P.; Kutala, B.K. Liver diseases: A major, neglected global public health problem requiring urgent actions and large-scale screening. Liver Int. 2018, 38 (Suppl. 1), 2–6. [Google Scholar] [CrossRef]
- Sarwar, R.; Pierce, N.; Koppe, S. Obesity and nonalcoholic fatty liver disease: Current perspectives. Diabetes Metab. Syndr. Obes. 2018, 11, 533–542. [Google Scholar] [CrossRef]
- Cholongitas, E.; Pavlopoulou, I.; Papatheodoridi, M.; Markakis, G.E.; Bouras, E.; Haidich, A.B.; Papatheodoridis, G. Epidemiology of nonalcoholic fatty liver disease in Europe: A systematic review and meta-analysis. Ann. Gastroenterol. 2021, 34, 404–414. [Google Scholar] [CrossRef]
- de Alwis, N.M.W.; Day, C.P. Non-alcoholic fatty liver disease: The mist gradually clears. J. Hepatol. 2008, 48, S104–S112. [Google Scholar] [CrossRef]
- Armstrong, M.J.; Adams, L.A.; Canbay, A.; Syn, W.K. Extrahepatic complications of nonalcoholic fatty liver disease. Hepatology 2014, 59, 1174–1197. [Google Scholar] [CrossRef]
- Chalasani, N.; Younossi, Z.; LaVine, J.E.; Charlton, M.; Cusi, K.; Rinella, M.; Harrison, S.A.; Brunt, E.M.; Sanyal, A.J. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018, 67, 328–357. [Google Scholar] [CrossRef] [PubMed]
- Muzurović, E.; Mikhailidis, D.P.; Mantzoros, C. Non-alcoholic fatty liver disease, insulin resistance, metabolic syndrome and their association with vascular risk. Metabolism 2021, 119, 154770. [Google Scholar] [CrossRef] [PubMed]
- Bedogni, G.; Gastaldelli, A.; Foschi, F.G. Fatty liver, cardiometabolic disease and mortality. Curr. Opin. Lipidol. 2020, 31, 27–31. [Google Scholar] [CrossRef] [PubMed]
- Caussy, C.; Aubin, A.; Loomba, R. The relationship between type 2 diabetes, NAFLD, and cardiovascular risk. Curr. Diab. Rep. 2021, 21, 15. [Google Scholar] [CrossRef]
- Vernon, G.; Baranova, A.; Younossi, Z.M. Systematic review: The epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment. Pharmacol. Ther. 2011, 34, 274–285. [Google Scholar] [CrossRef] [PubMed]
- Williams, R.; Alexander, G.; Armstrong, I.; Baker, A.; Bhala, N.; Camps-Walsh, G.; E Cramp, M.; de Lusignan, S.; Day, N.; Dhawan, A.; et al. Disease burden and costs from excess alcohol consumption, obesity, and viral hepatitis: Fourth report of the Lancet Standing Commission on Liver Disease in the UK. Lancet 2018, 391, 1097–1107. [Google Scholar] [CrossRef]
- Tsochatzis, E.A.; Newsome, P.N. Non-alcoholic fatty liver disease and the interface between primary and secondary care. Lancet Gastroenterol. Hepatol. 2018, 3, 509–517. [Google Scholar] [CrossRef] [PubMed]
- Standing, H.C.; Jarvis, H.; Orr, J.; Exley, C.; Hudson, M.; Kaner, E.; Hanratty, B. GPs’ experiences and perceptions of early detection of liver disease: A qualitative study in primary care. Br. J. Gen. Pract. 2018, 68, e743–e749. [Google Scholar] [CrossRef] [PubMed]
- Said, A.; Gagovic, V.; Malecki, K.; Givens, M.L.; Nieto, F.J. Primary care practitioners survey of non-alcoholic fatty liver disease. Ann. Hepatol. 2013, 12, 758–765. [Google Scholar] [CrossRef]
- Polanco-Briceno, S.; Glass, D.; Stuntz, M.; Caze, A. Awareness of nonalcoholic steatohepatitis and associated practice patterns of primary care physicians and specialists. BMC Res. Notes 2016, 9, 157. [Google Scholar] [CrossRef]
- Sebastiani, G.; Ramji, A.; Swain, M.G.; Patel, K. A Canadian survey on knowledge of non-alcoholic fatty liver disease among physicians. Can. Liver J. 2021, 4, 82–92. [Google Scholar] [CrossRef] [PubMed]
- Matthias, A.T.; Fernandopulle, A.N.R.; Seneviratne, S.L. Survey on knowledge of non-alcoholic fatty liver disease (NAFLD) among doctors in Sri Lanka: A multicenter study. BMC Res. Notes 2018, 11, 556. [Google Scholar] [CrossRef]
- Grattagliano, I.; D'Ambrosio, G.; D'Ambrozio, G.; Palmieri, V.O.; Moschetta, A.; Palasciano, G.; Portincasa, P. Improving nonalcoholic fatty liver disease management by general practitioners: A critical evaluation and impact of an educational training program. JGLD 2008, 17, 389–394. [Google Scholar] [PubMed]
- Francque, S.M.; Marchesini, G.; Kautz, A.; Walmsley, M.; Dorner, R.; Lazarus, J.V.; Zelber-Sagi, S.; Hallsworth, K.; Busetto, L.; Frühbeck, G.; et al. Non-alcoholic fatty liver disease: A patient guideline. JHEP Rep. 2021, 3, 100322. [Google Scholar] [CrossRef]
- Broder, M.S.; Gibbs, S.N.; Yermilov, I. An Adaptation of the RAND/UCLA Modified Delphi Panel Method in the Time of COVID-19. J. Healthc Leadersh. 2022, 14, 63–70. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Papadakis, S.; Anastasaki, M.; Gergianaki, I.; Koek, G.; Mendive, J.; Anastasiou, F.; Heyens, L.; Garcia-Retortillo, M.; Muris, J.; Lionis, C. Development and implementation of a continuing medical education program on non-alcoholic fatty liver disease for primary care practitioners in Europe. Front. Med. 2023, 10, 1034626. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Cusi, K.; Isaacs, S.; Barb, D.; Basu, R.; Caprio, S.; Garvey, W.T.; Kashyap, S.; Mechanick, J.I.; Mouzaki, M.; Nadolsky, K.; 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, 528–562. [Google Scholar] [CrossRef] [PubMed]
- Allen, A.M.; Charlton, M.; Cusi, K.; Harrison, S.A.; Kowdley, K.V.; Noureddin, M.; Shubrook, J.H. Guideline-based management of metabolic dysfunction-associated steatotic liver disease in the primary care setting. Postgrad. Med. 2024, 136, 229–245. [Google Scholar] [CrossRef]
Statement | Round 1 | Round 2 | ||
---|---|---|---|---|
N | % Agree | N | % Agree | |
R1 | 12 | 92 | 8 | 100 |
R2 | 12 | 92 | 8 | 100 |
R3 | 12 | 67 | 8 | 100 |
R4 | 12 | 100 | 8 | 100 |
R5 | 12 | 58 | 8 | 100 |
R6 | 12 | 92 | 8 | 100 |
R7 | 12 | 92 | 8 | 100 |
R8 | 12 | 92 | 8 | 100 |
R9 | 12 | 83 | 8 | 100 |
R10 | 12 | 75 | 8 | 100 |
R11 | 12 | 58 | 8 | 87.5 |
R12 | 12 | 58 | 8 | 87.5 |
R13 | 12 | 33 | 8 | Rejected |
R14 | 12 | 83 | 8 | 100 |
R15 | 12 | 75 | 8 | 100 |
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Lionis, C.; Papadakis, S.; Anastasaki, M.; Aligizakis, E.; Anastasiou, F.; Francque, S.; Gergianaki, I.; Mendive, J.M.; Marketou, M.; Muris, J.; et al. Practice Recommendations for the Management of MASLD in Primary Care: Consensus Results. Diseases 2024, 12, 180. https://doi.org/10.3390/diseases12080180
Lionis C, Papadakis S, Anastasaki M, Aligizakis E, Anastasiou F, Francque S, Gergianaki I, Mendive JM, Marketou M, Muris J, et al. Practice Recommendations for the Management of MASLD in Primary Care: Consensus Results. Diseases. 2024; 12(8):180. https://doi.org/10.3390/diseases12080180
Chicago/Turabian StyleLionis, Christos, Sophia Papadakis, Marilena Anastasaki, Eftihis Aligizakis, Foteini Anastasiou, Sven Francque, Irini Gergianaki, Juan Manuel Mendive, Maria Marketou, Jean Muris, and et al. 2024. "Practice Recommendations for the Management of MASLD in Primary Care: Consensus Results" Diseases 12, no. 8: 180. https://doi.org/10.3390/diseases12080180