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Abstract Details |
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A Global Survey of Physicians Knowledge About Non-alcoholic Fatty Liver Disease |
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Clin Gastroenterol Hepatol. 2021 Jul 3;S1542-3565(21)00719-9.
doi: 10.1016/j.cgh.2021.06.048.Online ahead of print.
Zobair M Younossi 1, Janus P Ong 2, Hirokazu Takahashi 3, Yusuf Yilmaz 4, Yuichiro Eguchi 5, Mohamed El Kassas 6, Maria Buti 7, Moisés Diago 8, Ming-Hua Zheng 9, Jian-Gao Fan 10, Ming-Lung Yu 11, Vincent Wai-Sun Wong 12, Khalid Alswat 13, Wah-Kheong Chan 14, Nahum Mendez-Sanchez 15, Patrizia Burra 16, Elisabetta Bugianesi 17, Ajay K Duseja 18, Jacob George 19, George V Papatheodoridis 20, Hamid Saeed 21, Laurent Castera 22, Marco Arrese 23, Marcelo Kugelmas 24, Manuel Romero-Gomez 25, Saleh Alqahtani 26, Mariam Ziayee 27, Brian Lam 28, Issah Younossi 27, Andrei Racila 28, Linda Henry 27, Maria Stepanova 27, Global NASH Council
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Author information
- 1Center 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: Zobair.Younossi@inova.org.
- 2University of the Philippines, College of Medicine, Manila, Philippines.
- 3Liver Center, Saga University Hospital, Saga, Japan.
- 4Department of Gastroenterology, School of Medicine, Istanbul, Turkey; Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
- 5Locomedical General Institute, Locomedical Medical Cooperation, Ogi, Saga, Japan.
- 6Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
- 7Liver Unit, Vall d'Hebron University Hospital, CIBER-EHD del Instituto Carlos III, Barcelona, Spain.
- 8Departamento de Patología Digestiva, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
- 9Nonalcoholic Fatty Liver Disease Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- 10Center for Fatty Liver, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiatong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China.
- 11Hepatobiliary Section, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- 12Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
- 13Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- 14Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
- 15Liver Research Unit, Medica Sur Clinic and Foundation, National Autonomous University of Mexico, Mexico City, Mexico.
- 16Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
- 17Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, Italy.
- 18Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
- 19Storr Liver Centre, Westmead Hospital, University of Sydney, Sydney, Australia.
- 20National and Kapodistrian University of Athens, Athens, Greece.
- 21Department of Medicine, Aga Khan University, Karachi, Pakistan.
- 22Department of Hepatology, Hôpital Beaujon, University of Paris, Clichy, France.
- 23Departmento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
- 24South Denver Gastroenterology, PC, Denver, Colorado.
- 25Digestive Diseases Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain.
- 26King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Center for Outcomes Research in Liver Disease, Washington, District of Columbia.
- 27Center for Outcomes Research in Liver Disease, Washington, District of Columbia.
- 28Center 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.
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.
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