A Global Survey of Physicians Knowledge About Nonalcoholic Fatty Liver Disease

Zobair M Younossi; Janus P Ong; Hirokazu Takahashi; Yusuf Yilmaz; Yuichiro Eguc Hi; Mohamed El Kassas; Maria Buti; Moisés Diago; Ming-Hua Zheng; Jian-Gao Fan; Ming-Lung Yu; Vincent Wai-Sun Wong; Khalid Alswat; Wah-Kheong Chan; Nahum Mendez-Sanchez; Patrizia Burra; Elisabetta Bugianesi; Ajay K Duseja; Jacob George; George V Papatheodoridis; Hamid Saeed; Laurent Castera; Marco Arrese; Marcelo Kugelmas; Manuel Romero-Gomez; Saleh Alqahtani; Mariam Ziayee; Brian Lam; Issah Younossi; Andrei Racila; Linda Henry; Maria Stepanova; Global Nonalcoholic Steatohepatitis Council

doi:10.1016/j.cgh.2021.06.048

A Global Survey of Physicians Knowledge About Nonalcoholic Fatty Liver Disease

Clin Gastroenterol Hepatol. 2022 Jun;20(6):e1456-e1468. doi: 10.1016/j.cgh.2021.06.048. Epub 2021 Jul 3.

Authors

Zobair M Younossi¹, Janus P Ong², Hirokazu Takahashi³, Yusuf Yilmaz⁴, Yuichiro Eguc Hi⁵, Mohamed El Kassas⁶, Maria Buti⁷, Moisés Diago⁸, Ming-Hua Zheng⁹, Jian-Gao Fan¹⁰, Ming-Lung Yu¹¹, Vincent Wai-Sun Wong¹², Khalid Alswat¹³, Wah-Kheong Chan¹⁴, Nahum Mendez-Sanchez¹⁵, Patrizia Burra¹⁶, Elisabetta Bugianesi¹⁷, Ajay K Duseja¹⁸, Jacob George¹⁹, George V Papatheodoridis²⁰, Hamid Saeed²¹, Laurent Castera²², Marco Arrese²³, Marcelo Kugelmas²⁴, Manuel Romero-Gomez²⁵, Saleh Alqahtani²⁶, Mariam Ziayee²⁷, Brian Lam²⁸, Issah Younossi²⁷, Andrei Racila²⁸, Linda Henry²⁷, Maria Stepanova²⁷; Global Nonalcoholic Steatohepatitis Council

Affiliations

¹ Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia; Inova Medicine, Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia. Electronic address: [email protected].
² University of the Philippines, College of Medicine, Manila, Philippines.
³ Liver Center, Saga University Hospital, Saga, Japan.
⁴ Department of Gastroenterology, School of Medicine, Istanbul, Turkey; Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
⁵ Locomedical General Institute, Locomedical Medical Cooperation, Ogi, Saga, Japan.
⁶ Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
⁷ Liver Unit, Vall d'Hebron University Hospital, CIBER-EHD del Instituto Carlos III, Barcelona, Spain.
⁸ Departamento de Patología Digestiva, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
⁹ Nonalcoholic Fatty Liver Disease Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
¹⁰ Center for Fatty Liver, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiatong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China.
¹¹ Hepatobiliary Section, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹² Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
¹³ Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
¹⁴ Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
¹⁵ Liver Research Unit, Medica Sur Clinic and Foundation, National Autonomous University of Mexico, Mexico City, Mexico.
¹⁶ Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
¹⁷ Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, Italy.
¹⁸ Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
¹⁹ Storr Liver Centre, Westmead Hospital, University of Sydney, Sydney, Australia.
²⁰ National and Kapodistrian University of Athens, Athens, Greece.
²¹ Department of Medicine, Aga Khan University, Karachi, Pakistan.
²² Department of Hepatology, Hôpital Beaujon, University of Paris, Clichy, France.
²³ Departmento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
²⁴ South Denver Gastroenterology, PC, Denver, Colorado.
²⁵ Digestive Diseases Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain.
²⁶ King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Center for Outcomes Research in Liver Disease, Washington, District of Columbia.
²⁷ Center for Outcomes Research in Liver Disease, Washington, District of Columbia.
²⁸ Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia; Inova Medicine, Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia.

PMID: 34229038
DOI: 10.1016/j.cgh.2021.06.048

Abstract

Background & aims: Despite rapidly increasing nonalcoholic fatty liver disease (NAFLD) prevalence, providers' knowledge may be limited. We assessed NAFLD knowledge and associated factors among physicians of different specialties globally.

Methods: NAFLD knowledge surveys containing 54 and 59 questions covering 3 domains (epidemiology/pathogenesis, diagnostics, and treatment) were completed electronically by hepatologists, gastroenterologists (GEs), endocrinologists (ENDOs), and primary care physicians (PCPs) from 40 countries comprising 5 Global Burden of Disease super-regions. Over 24 months, 2202 surveys were completed (488 hepatologists, 758 GEs, 148 ENDOs, and 808 PCPs; 50% high-income Global Burden of Disease super-region, 27% from North Africa and Middle East, 12% Southeast Asia, and 5% South Asian and Latin America).

Results: Hepatologists saw the greatest number of NAFLD patients annually: median 150 (interquartile range, 60-300) vs 100 (interquartile range, 35-200) for GEs, 100 (interquartile range, 30-200) for ENDOs, and 10 (interquartile range, 4-50) for PCPs (all P < .0001). The primary sources of NAFLD knowledge acquisition for hepatologists were international conferences (33% vs 8%-26%) and practice guidelines for others (39%-44%). The Internet was the second most common source of NAFLD knowledge for PCPs (28%). NAFLD knowledge scores were higher for hepatologists than GEs: epidemiology, 62% vs 53%; diagnostics, 80% vs 73%; and treatment, 61% vs 58% (P < .0001), and ENDOs scores were higher than PCPs: epidemiology, 70% vs 60%; diagnostics, 71% vs 64%; and treatment, 79% vs 68% (P < .0001). Being a hepatologist or ENDO was associated with higher knowledge scores than a GE or PCP, respectively (P < .05). Higher NAFLD knowledge scores were associated independently with a greater number of NAFLD patients seen (P < .05).

Conclusions: Despite the growing burden of NAFLD, a significant knowledge gap remains for the identification, diagnosis, and management of NAFLD.

Keywords: Cardiovascular Disease; Endocrinologists; Guidelines; Internet; Primary Care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Latin America / epidemiology
Non-alcoholic Fatty Liver Disease* / diagnosis
Non-alcoholic Fatty Liver Disease* / epidemiology
Non-alcoholic Fatty Liver Disease* / therapy
Physicians*
Prevalence
Surveys and Questionnaires