A global survey of health care workers' awareness of non-alcoholic fatty liver disease: The AwareNASH survey

Stan Driessen*, Vivian D de Jong, Koen C van Son, Tatiana Klompenhouwer, Yann Colardelle, Marco Alings, Cristophe Moreno, Stefan D Anker, Manuel Castro Cabezas, Adriaan G Holleboom, Diederick E Grobbee, Maarten E Tushuizen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND: The estimated global prevalence and burden of non-alcoholic fatty liver disease (NAFLD) and its advanced stage, non-alcoholic steatohepatitis (NASH), is increasing. Yet, NAFLD remains largely underdiagnosed. In addition to hepatic morbidity and mortality, NAFLD is associated with increased cardiovascular complications, warranting a multidisciplinary approach. Despite its rapidly increasing prevalence, knowledge of NAFLD among healthcare workers is limited, especially with specialists outside the field of hepatology and gastroenterology.

OBJECTIVES: To investigate knowledge, practice and opinions/attitudes of healthcare workers towards diagnosis and management of NAFLD/NASH.

METHODS: The survey was designed in collaboration with a multidisciplinary scientific committee established especially for this study. The survey was disseminated to healthcare workers from seven different disciplines through four collaborating societies, social media and at a cardiology-themed conference from February to June 2022. Median and interquartile range were mentioned for numeric responses and proportions for categorical responses or responses on a Likert scale. Likert scale responses were treated as ordinal data and analysed with the appropriate tests.

RESULTS: The full dataset included 613 respondents from 88 different countries (including 488 physicians). 64% of the surveyed physicians underestimated the prevalence of NAFLD. General practitioners and cardiologists underestimated the prevalence most often (74% and 77%, respectively). Compared to the other disciplines, cardiologists were least familiar with the symptoms and diagnostic criteria and felt least confident in diagnosing and managing NAFLD. Overall, 65% of physicians reported regularly using evidence-based guidelines for managing NAFLD, yet 72% reported challenges in providing lifestyle recommendations. A lack of awareness was the most common reported reason for the lack of screening for NAFLD (68% respectively).

CONCLUSIONS: Despite the growing burden of NAFLD, there is a significant gap in awareness, knowledge, and management among physicians treating patients with cardiometabolic comorbidities, particularly cardiologists. Hepatologists and gastroenterologists could play a role in educating their fellow physicians.

Original languageEnglish
Pages (from-to)654-662
Number of pages9
JournalUnited European Gastroenterology Journal
Volume11
Issue number7
Early online date10 Aug 2023
DOIs
Publication statusPublished - Sept 2023

Keywords

  • awareness
  • cardiologists
  • cardiovascular complications
  • healthcare workers
  • multidisciplinary approach
  • NAFLD
  • NASH
  • non-alcoholic fatty liver disease
  • non-alcoholic steatohepatitis
  • survey

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