Castera Laurent, Alazawi William, Bugianesi Elisabetta, Caussy Cyrielle, Federici Massimo, Romero-Gómez Manuel, Schattenberg Jörn M, Basuroy Ron, Prasad Preethy, Estulin Dmitry, Lazarus Jeffrey V
Department of Hepatology, Beaujon Hospital, AP-HP, Université Paris-Cité, Clichy, France.
Barts Liver Centre, Queen Mary University of London, London, UK.
Liver Int. 2025 Feb;45(2):e16224. doi: 10.1111/liv.16224.
Metabolic dysfunction-associated steatotic liver disease (MASLD) and its more severe subtype, metabolic dysfunction-associated steatohepatitis (MASH), are highly prevalent and strongly associated with obesity and type 2 diabetes (T2D). This study sought to identify challenges to the diagnosis, treatment and management of people living with MASLD and MASH and understand the key barriers to adopting relevant clinical guidelines.
A real-world, cross-sectional study (BARRIERS-MASLD) consisting of a quantitative survey and qualitative interviews of physicians in France, Germany, Italy, Spain and the United Kingdom was conducted from March to September 2023. Descriptive statistics were used for data analysis.
A total of 626 physicians completed the survey; n = 10 from each country participated in the qualitative interviews. Physicians considered the presence of MASH to be highly impactful on how they treated people living with obesity (66%) and T2D (69%). Over one-third (35%) of the respondents could not identify any MASH-specific clinical guidelines issued by medical societies or associations top-of-mind, but overall awareness rose when prompted about country-specific guidelines. Physicians said they would need evidence of success (48%) and clinical guidelines that address common MASLD comorbidities (38%) to increase their adoption.
This study found that lack of awareness around MASLD and MASH clinical guidelines and clearly established care pathways, particularly for addressing common comorbidities, was a key factor preventing physicians from optimising care for people living with MASH in Europe. This research highlights opportunities to improve education and training about clinical guidelines and care coordination.
代谢功能障碍相关脂肪性肝病（MASLD）及其更严重的亚型代谢功能障碍相关脂肪性肝炎（MASH）非常普遍，且与肥胖和2型糖尿病（T2D）密切相关。本研究旨在确定MASLD和MASH患者在诊断、治疗和管理方面面临的挑战，并了解采用相关临床指南的主要障碍。
2023年3月至9月，在法国、德国、意大利、西班牙和英国开展了一项真实世界横断面研究（BARRIERS-MASLD），包括对医生的定量调查和定性访谈。数据分析采用描述性统计方法。
共有626名医生完成了调查；每个国家有10名医生参与了定性访谈。医生认为MASH的存在对他们治疗肥胖患者（66%）和T2D患者（69%）的方式有很大影响。超过三分之一（35%）的受访者一时想不起任何医学协会发布的MASH特异性临床指南，但当被提及特定国家的指南时，总体认知度有所提高。医生表示，他们需要成功的证据（48%）以及针对MASLD常见合并症的临床指南（38%），才会更多地采用这些指南。
本研究发现，对MASLD和MASH临床指南以及明确的护理路径缺乏认知，尤其是针对常见合并症的处理，是阻碍欧洲医生优化MASH患者护理的关键因素。这项研究凸显了改善临床指南教育和培训以及护理协调的机会。
