{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T11:29:49Z","timestamp":1780572589029,"version":"3.54.1"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T00:00:00Z","timestamp":1650931200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T00:00:00Z","timestamp":1650931200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>Differences between countries in NAFLD patient care pathways and management need to be understood prior to defining supranational guidelines.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>We conducted an anonymous survey in France, Germany, Hong Kong, Italy, Romania, Spain, the United Kingdom, and the United States among physicians providing specialist care for patients with NAFLD. Modalities of patient referral, patterns of practice (diagnosis, staging, monitoring, and indications for liver biopsy), therapeutic management, and expectations for future NASH pharmacotherapies were assessed, with 664 physicians completing the survey. Referral to surveyed physicians (SPs) mostly came from primary care. Prior to referral, NAFLD was rarely diagnosed, and noninvasive tests were not performed. Screening for comorbidities by SPs was incomplete and cardiovascular risk not calculated. Elastometry in combination with a serum biomarker was the most common first\u2010line method for fibrosis staging. Liver biopsy, when performed, was often delayed by at least 1 year after diagnosis. It was, however, recommended even if noninvasive methods indicated advanced fibrosis. Frequent, biannual monitoring was conducted, including HCC surveillance in Stage 3 fibrosis. SPs rarely implemented and followed dietary and lifestyle changes themselves, and local availability of such programs was highly heterogenous. SPs favored pharmacotherapy based on mechanism of action adapted to the stage of the disease, including for early stages such as steatohepatitis with mild fibrosis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>This international survey revealed major deficiencies and delays in referral pathways, suboptimal screening for comorbidities or managing of lifestyle modifications by SPs, and limited local availability for nonpharmacological interventions. Monitoring practices are not aligned with current guidelines.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.32500","type":"journal-article","created":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T19:19:02Z","timestamp":1648840742000},"page":"1766-1777","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":16,"title":["An international survey on patterns of practice in NAFLD and expectations for therapies\u2014The POP\u2010NEXT project"],"prefix":"10.1097","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6865-3791","authenticated-orcid":false,"given":"Vlad","family":"Ratziu","sequence":"first","affiliation":[{"name":"Sorbonne Universit\u00e9, Hospital Piti\u00e9\u2010Salp\u00eatri\u00e8re,Paris,France"},{"name":"Institute for Cardiometabolism and Nutrition (ICAN),Paris,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9518-0088","authenticated-orcid":false,"given":"Quentin M.","family":"Anstee","sequence":"additional","affiliation":[{"name":"5994,Translational and Clinical Research Institute,Faculty of Medical Sciences,Newcastle University,Newcastle upon Tyne,UK"},{"name":"Newcastle NIHR Biomedical Research Centre,Newcastle upon Tyne Hospitals NHS Foundation Trust,Newcastle upon Tyne,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2215-9410","authenticated-orcid":false,"given":"Vincent Wai\u2010Sun","family":"Wong","sequence":"additional","affiliation":[{"name":"The Chinese University of Hong Kong,Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4224-4703","authenticated-orcid":false,"given":"J\u00f6rn M.","family":"Schattenberg","sequence":"additional","affiliation":[{"name":"Metabolic Liver Research Program, I. Department of Medicine,University Medical Center,Mainz,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Bugianesi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology,Department of Medical Sciences,University of Turin,Turin,Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvador","family":"Augustin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liana","family":"Gheorghe","sequence":"additional","affiliation":[{"name":"Center for Digestive Diseases and Liver Transplantation,Fundeni Clinical Institute,Carol Davila University of Medicine and Pharmacy,Bucharest,Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6048-2748","authenticated-orcid":false,"given":"Vittoria","family":"Zambon","sequence":"additional","affiliation":[{"name":"Institute for Cardiometabolism and Nutrition (ICAN),Paris,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2290-4580","authenticated-orcid":false,"given":"Nancy","family":"Reau","sequence":"additional","affiliation":[{"name":"Section of Hepatology,Rush University Medical Center,Chicago,Illinois,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,4,26]]},"reference":[{"key":"hep32500-bib-0001-20250415","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jhep.2019.08.027","article-title":"A cross\u2010sectional study of the public health response to non\u2010alcoholic fatty liver disease in Europe","volume":"72","year":"2020","journal-title":"J Hepatol"},{"issue":"4","key":"hep32500-bib-0002-20250415","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.jhep.2021.10.025","article-title":"The global NAFLD policy review and preparedness index: Are countries ready to address this silent public health challenge?","volume":"76","year":"2022","journal-title":"J Hepatol"},{"key":"hep32500-bib-0003-20250415","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1038\/s41575-021-00477-7","article-title":"Defining comprehensive models of care for NAFLD","volume":"18","year":"2021","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"hep32500-bib-0004-20250415","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jhep.2020.03.036","article-title":"Enhanced liver fibrosis test for the non\u2010invasive diagnosis of fibrosis in patients with NAFLD: a systematic review and meta\u2010analysis","volume":"73","year":"2020","journal-title":"J Hepatol"},{"key":"hep32500-bib-0005-20250415","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1016\/j.metabol.2016.05.004","article-title":"Nonalcoholic fatty liver disease and obstructive sleep apnea","volume":"65","year":"2016","journal-title":"Metabolism"},{"key":"hep32500-bib-0006-20250415","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1016\/j.jhep.2017.08.024","article-title":"Development of chronic kidney disease in patients with non\u2010alcoholic fatty liver disease: a cohort study","volume":"67","year":"2017","journal-title":"J Hepatol"},{"key":"hep32500-bib-0007-20250415","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.jhep.2019.03.033","article-title":"Prospective evaluation of a primary care referral pathway for patients with non\u2010alcoholic fatty liver disease","volume":"71","year":"2019","journal-title":"J Hepatol"},{"issue":"75","key":"hep32500-bib-0008-20250415","first-page":"659","article-title":"EASL clinical practice guidelines on non\u2010invasive tests for evaluation of liver disease severity and prognosis\u20142021 update","volume":"2021","year":"2021","journal-title":"J Hepatol"},{"key":"hep32500-bib-0009-20250415","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/S2468-1253(19)30383-8","article-title":"FibroScan\u2010AST (FAST) score for the non\u2010invasive identification of patients with non\u2010alcoholic steatohepatitis with significant activity and fibrosis: a prospective derivation and global validation study","volume":"5","year":"2020","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"hep32500-bib-0010-20250415","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/S2468-1253(20)30252-1","article-title":"A blood\u2010based biomarker panel (NIS4) for non\u2010invasive diagnosis of nonalcoholic steatohepatitis and liver fibrosis: a prospective derivation and global validation study","volume":"5","year":"2020","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"4","key":"hep32500-bib-0011-20250415","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.jhep.2021.11.012","article-title":"MRI\u2010based (MAST) score accurately identifies patients with NASH and significant fibrosis","volume":"76","year":"2022","journal-title":"J Hepatol"},{"key":"hep32500-bib-0012-20250415","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1016\/S0140-6736(20)32511-3","article-title":"Non\u2010alcoholic fatty liver disease","volume":"397","year":"2021","journal-title":"Lancet"},{"key":"hep32500-bib-0013-20250415","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1056\/NEJMoa2029349","article-title":"Prospective study of outcomes in adults with nonalcoholic fatty liver disease","volume":"385","year":"2021","journal-title":"N Engl J Med"},{"key":"hep32500-bib-0014-20250415","doi-asserted-by":"crossref","first-page":"2230","DOI":"10.1002\/hep.30094","article-title":"Healthcare cost and utilization in nonalcoholic fatty liver disease: real\u2010world data from a large U.S. claims database","volume":"68","year":"2018","journal-title":"Hepatology"},{"key":"hep32500-bib-0015-20250415","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1053\/j.gastro.2007.10.024","article-title":"Impact of fatty liver disease on health care utilization and costs in a general population: a 5\u2010year observation","volume":"134","year":"2008","journal-title":"Gastroenterology"},{"key":"hep32500-bib-0016-20250415","doi-asserted-by":"crossref","first-page":"1822","DOI":"10.1053\/j.gastro.2019.12.053","article-title":"AGA clinical practice update on screening and surveillance for hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: expert review","volume":"158","year":"2020","journal-title":"Gastroenterology"},{"key":"hep32500-bib-0017-20250415","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.jhep.2019.05.008","article-title":"Models estimating risk of hepatocellular carcinoma in patients with alcohol or NAFLD\u2010related cirrhosis for risk stratification","volume":"71","year":"2019","journal-title":"J Hepatol"},{"key":"hep32500-bib-0018-20250415","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/j.jhep.2021.04.044","article-title":"Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta\u2010analysis","volume":"75","year":"2021","journal-title":"J Hepatol"},{"key":"hep32500-bib-0019-20250415","article-title":"Diagnostic accuracy of non\u2010invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta\u2010analysis","year":"2021","journal-title":"Gut"},{"key":"hep32500-bib-0020-20250415","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/j.jhep.2020.06.007","article-title":"Repeated FIB\u20104 measurements can help identify individuals at risk of severe liver disease","volume":"73","year":"2020","journal-title":"J Hepatol"},{"key":"hep32500-bib-0021-20250415","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.jhep.2020.11.050","article-title":"Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease","volume":"74","year":"2021","journal-title":"J Hepatol"},{"key":"hep32500-bib-0022-20250415","article-title":"Non\u2010invasive tests accurately stratify patients with NAFLD based on their risk of liver\u2010related events","year":"2022","journal-title":"J Hepatol"},{"key":"hep32500-bib-0023-20250415","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1053\/j.gastro.2020.01.043","article-title":"Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: a systematic review and meta\u2010analysis","volume":"158","year":"2020","journal-title":"Gastroenterology"},{"key":"hep32500-bib-0024-20250415","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1053\/j.gastro.2018.04.034","article-title":"Fibrosis severity as a determinant of cause\u2010specific mortality in patients with advanced nonalcoholic fatty liver disease: a multi\u2010national cohort study","volume":"155","year":"2018","journal-title":"Gastroenterology"},{"key":"hep32500-bib-0025-20250415","doi-asserted-by":"crossref","first-page":"100411","DOI":"10.1016\/j.jhepr.2021.100411","article-title":"Real\u2010world management of non\u2010alcoholic steatohepatitis differs from clinical practice guideline recommendations and across regions","volume":"4","year":"2022","journal-title":"JHEP Rep"}],"container-title":["Hepatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hep.32500","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hep.32500","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1002\/hep.32500","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T16:42:09Z","timestamp":1744735329000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1002\/hep.32500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,26]]},"references-count":25,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1002\/hep.32500","relation":{},"ISSN":["0270-9139","1527-3350"],"issn-type":[{"value":"0270-9139","type":"print"},{"value":"1527-3350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,26]]},"assertion":[{"value":"2022-02-08","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-28","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}