A Global Survey of Physicians Knowledge About Nonalcoholic Fatty Liver Disease
Open accessAbstract
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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The sheer volume of medical knowledge makes staying up to date regarding management of chronic medical conditions challenging.
“Although the present study demonstrated that OE reinforced the CDM by the PCPs in commonly treated conditions, the sheer volume of medical knowledge makes staying up to date regarding management of chronic medical conditions challenging. 12”
From The use of an artificial intelligence platform OpenEvidence to augment clinical decision-making for primary care physicians (2025) · cites this paper as [12]
The Discussion (page unavailable) reports knowledge gaps about NAFLD, especially among primary care physicians, and recommends regular webinars on new updates. This supports a narrower point about keeping physicians informed on NAFLD, but the paper does not attribute the difficulty to the sheer volume of medical knowledge or address management of chronic conditions generally. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIn a recent global survey of MASLD, knowledge scores were significantly higher in HEP, ENDO, and GI physicians in every domain (diagnosis, epidemiology, treatment) compared to PCPs.
“A recent global survey of Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) was conducted to assess knowledge among PCPs, hepatologists (HEP), gastroenterologists (GI), and endocrinologists (ENDO). The knowledge scores were significantly higher in HEP, ENDO, and GI physicians in every domain (i.e., diagnosis, epidemiology, and treatment) when compared to PCPs. 12”
From The use of an artificial intelligence platform OpenEvidence to augment clinical decision-making for primary care physicians (2025) · cites this paper as [12]
The Awareness and Knowledge section (page not specified) reports significantly higher scores for endocrinologists than PCPs in all three domains. It compares hepatologists with gastroenterologists on a separate survey version, not either group with PCPs; the Methods section confirms the two versions differed. The paper describes its subject as NAFLD, rather than MASLD. (LLM, conf=0.91)
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- CRediT Authorship Contributions Zobair M. Younossi, MD (Conceptualization: Lead; Investigation: Lead; Methodology: Lead; Supervision: Lead; Writing -original draft: Equal; Writing - review & editing: Lead)
- Janus P. Ong (Investigation: Supporting; Writing -original draft: Lead; Writing -review & editing: Supporting) Hirokazu Takahashi (Data curation: Equal; Writing -review & editing: Equal)
- Yusuf Yilmaz (Data curation: Equal; Writing -review & editing: Equal) Yuichiro Eguchi (Data curation: Equal; Writing -review & editing: Equal) Mohamed El Kassas (Data curation: Equal; Writing -review & editing: Equal)
- Maria Buti (Data curation: Equal; Writing -review & editing: Equal) Moisés Diago (Data curation: Equal; Writing -review & editing: Equal)
- Ming-Hua Zheng (Data curation: Equal; Writing -review & editing: Equal)
- Jian-Gao Fan (Data curation: Equal; Writing -review & editing: Equal)
- Ming-Lung Yu (Data curation: Equal; Writing -review & editing: Equal)
- Vincent Wai-Sun Wong (Data curation: Equal; Writing -review & editing: Equal) Khalid Alswat (Data curation: Equal; Writing -review & editing: Equal) Wah-Kheong Chan (Data curation: Equal; Writing -review & editing: Equal) Nahum Mendez-Sanchez (Data curation: Equal; Writing -review & editing: Equal)
- Patrizia Burra (Data curation: Equal; Writing -review & editing: Equal) Elisabetta Bugianesi (Data curation: Equal; Writing -review & editing: Equal)
- Ajay K. Duseja (Data curation: Equal; Writing -review & editing: Equal)
- Jacob George (Data curation: Equal; Writing -review & editing: Equal)
- George V. Papatheodoridis (Data curation: Equal; Writing -review & edit- ing: Equal)
- Hamid Saeed (Data curation: Equal; Writing -review & editing: Equal)
- Laurent Castera (Data curation: Equal; Writing -review & editing: Equal) Marco Arrese (Data curation: Equal; Writing -review & editing: Equal) Marcelo Kugelmas (Data curation: Equal; Writing -review & editing: Equal)
- Manuel Romero-Gomez (Data curation: Equal; Writing -review & editing: Equal) Saleh Alqahtani (Data curation: Equal; Writing -review & editing: Equal) Mariam Ziayee (Data curation: Equal; Writing -review & editing: Equal)
- Brian Lam (Data curation: Equal; Writing -review & editing: Equal)
- Issah Younossi (Project administration: Lead) Andrei Racila (Data curation: Supporting; Project administration: Equal; Software: Lead) Linda Henry (Writing -original draft: Supporting; Writing -review & editing: Lead) Maria Stepanova (Formal analysis: Lead; Methodology: Lead; Writing - original draft: Equal; Writing -review & editing: Equal)
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“12 A recent global survey of Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) was conducted to assess knowledge among PCPs, hepatologists (HEP), gastroenterologists (GI), and endocrinologists (ENDO).”
InfluentialZhang, X., Yip, T. C.-F., Wong, G. L.-H., Leow, W.-X., Liang, L. Y., Lim, L.-L., Li, G., Ibrahim, L., Lin, H., Lai, J. C. T., et al. (2023) · Gut · doi:10.1136/gutjnl-2023-330269 · Cited by 55 · see citing works
Self-citation
- Authors
- Younossi, Z. M., Ong, J. P., Takahashi, H., Yilmaz, Y., Eguc`hi, Y., El Kassas, M., Buti, M., Diago, M., Zheng, M.-H., Fan, J.-G., Yu, M.-L., Wai-Sun Wong, V., Alswat, K., Chan, W.-K., Mendez-Sanchez, N., Burra, P., Bugianesi, E., Duseja, A. K., George, J., Papatheodoridis, G. V., Saeed, H., Castera, L., Arrese, M., Kugelmas, M., Romero-Gomez, M., Alqahtani, S., Ziayee, M., Lam, B., Younossi, I., Racila, A., Henry, L., & Stepanova, M.
- Affiliations
- Inova Health System (US)
- University of the Philippines Manila (PH)
- Saga University (JP)
- Istanbul University (TR)
- First Affiliated Hospital of Wenzhou Medical University (CN)
- Shanghai Jiao Tong University (CN)
- Kaohsiung Medical University (TW)
- King Saud University (SA)
- University of Malaya (MY)
- Azienda Ospedale - Università Padova (IT)
- University of Turin (IT)
- Post Graduate Institute of Medical Education and Research (IN)
- The University of Sydney (AU)
- National and Kapodistrian University of Athens (GR)
- Aga Khan University (PK)
- Pontificia Universidad Católica de Chile (CL)
- King Faisal Specialist Hospital & Research Centre (SA)
- Center for Outcomes Research in Liver Diseases (US)
- Corresponding author
- Younossi, Zobair M.
- ORCID
- Younossi, Zobair M.
- Ong, Janus P.
- Takahashi, Hirokazu
- Yilmaz, Yusuf
- Zheng, Ming-Hua
- Fan, Jian-Gao
- Yu, Ming-Lung
- Alswat, Khalid
- Chan, Wah-Kheong
- Burra, Patrizia
- Bugianesi, Elisabetta
- Duseja, Ajay K.
- George, Jacob
- Papatheodoridis, George V.
- Arrese, Marco
- Kugelmas, Marcelo
- Alqahtani, Saleh
- Lam, Brian
- Henry, Linda
- Stepanova, Maria
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2022-06
- Volume
- 20
- Issue
- 6
- Pages
- e1456-e1468
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W3181177767
- Cited by
- 115
- References
- 3
- Citations by year
- 2026: 15 · 2025: 22 · 2024: 30 · 2023: 25 · 2022: 17 · 2021: 6
- FWCI
- 14.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Dspace Repository (Marmara Üniversitesi) (submittedVersion)
- DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion)
- Deposito de Investigacion Universidad de Sevilla (University of Seville) (submittedVersion, cc-by-nc-nd)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Keywords
- non-alcoholic fatty liver disease, physician knowledge, NAFLD pathogenesis, NAFLD diagnosis, NAFLD treatment, hepatologists, gastroenterologists, endocrinologists, primary care physicians, physician specialty differences, NAFLD prevalence, physician training needs
- MeSH terms
- Humans, Latin America, Physicians, Surveys and Questionnaires, Prevalence, Non-alcoholic Fatty Liver Disease
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