{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T11:20:27Z","timestamp":1787916027253,"version":"build-2784847793"},"reference-count":45,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,17]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore gastroenterologists\u2019 perspectives on the changing epidemiology of non-alcoholic fatty liver disease (NAFLD) in Pakistan and identify barriers to its diagnosis and management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Qualitative exploratory study using face-to-face semi-structured in-depth interviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings<\/jats:title>\n                    <jats:p>Public and private healthcare settings in Islamabad, Rawalpindi and surrounding regions of Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>22 consultant gastroenterologists and postgraduate trainees in gastroenterology registered with the Pakistan Medical and Dental Council, with over 2 years of clinical experience managing patients with NAFLD. Participants were recruited through purposive sampling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcomes<\/jats:title>\n                    <jats:p>Primary outcomes included physicians\u2019 perceptions of epidemiological changes, risk factors, clinical presentation patterns and barriers to NAFLD care. Secondary outcomes included proposed strategies for prevention and management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five major themes emerged from thematic analysis: (1) changing epidemiology\u2014alarming rises in prevalence, demographic shift toward younger adults (20\u201330 years), and increasing presentation with advanced disease; (2) multifactorial risk factors\u2014poor diet, sedentary lifestyle, metabolic comorbidities including diabetes and obesity, hypertension and genetic-hormonal influences; (3) clinical presentation\u2014asymptomatic early disease with incidental detection, non-specific symptoms, and distinct gender-occupational patterns (housewives, post-menopausal women, sedentary professionals); (4) significant barriers to care\u2014profound patient unawareness, poor compliance with lifestyle modifications, diagnostic limitations (FibroScan unavailability) and financial constraints restricting access to advanced diagnostics and pharmacotherapy (pharmacotherapy including newer agents such as Resmetirom for metabolic dysfunction-associated steatohepatitis); (5) proposed strategies\u2014public awareness campaigns, targeted screening programmes, lifestyle modification and multidisciplinary collaborative care models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>NAFLD in Pakistan represents a silent epidemic with alarming epidemiological shifts towards younger populations and advanced disease. Urgent implementation of multifaceted strategies including public awareness campaigns, targeted screening of at-risk populations and multidisciplinary collaborative care models is imperative.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119696","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T11:05:47Z","timestamp":1787915147000},"page":"e119696","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Perspectives of gastroenterologists on the evolving epidemiology and management of non-alcoholic fatty liver disease in Pakistan: a qualitative study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0007-0469","authenticated-orcid":false,"given":"Muhammad Ebad","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, Faculty of Pharmacy, Hamdard University - Islamabad Campus, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5253-1538","authenticated-orcid":false,"given":"Matti","family":"Ullah","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Faculty of Pharmacy, Hamdard University - Islamabad Campus, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Usman","family":"Khan","sequence":"additional","affiliation":[{"name":"Pharmacy, Iqra University - Islamabad Campus, Islamabad, H-9 Campus, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alishba","family":"Bibi","sequence":"additional","affiliation":[{"name":"Bachelor of Generic Nursing, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology - Islamabad Campus, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayyab","family":"Tariq","sequence":"additional","affiliation":[{"name":"Pharmacy, Iqra University - Islamabad Campus, Islamabad, H-9 Campus, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adina","family":"Mahnoor","sequence":"additional","affiliation":[{"name":"Pharmacy, Iqra University - Islamabad Campus, Islamabad, H-9 Campus, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muqaddas","family":"Rasool","sequence":"additional","affiliation":[{"name":"Pharmacy, Iqra University - Islamabad Campus, Islamabad, H-9 Campus, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Nasir","sequence":"additional","affiliation":[{"name":"Pharmacy, Iqra University - Islamabad Campus, Islamabad, H-9 Campus, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja Ahmad","family":"Sohaib","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Faculty of Pharmacy, Hamdard University - Islamabad Campus, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waqas","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Gastroenterology, Rawalpindi Medical University, Rawalpindi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahnoor","family":"Ali","sequence":"additional","affiliation":[{"name":"Pharmacy, Iqra University - Islamabad Campus, Islamabad, H-9 Campus, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malaika","family":"Nasir","sequence":"additional","affiliation":[{"name":"Pharmacy, Iqra University - Islamabad Campus, Islamabad, H-9 Campus, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uzma","family":"Nawaz","sequence":"additional","affiliation":[{"name":"Pharmacy, Iqra University - Islamabad Campus, Islamabad, H-9 Campus, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Abu","family":"Hurairah","sequence":"additional","affiliation":[{"name":"Pharmacy, Iqra University - Islamabad Campus, Islamabad, H-9 Campus, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"2026082804051255000_16.8.e119696.1","doi-asserted-by":"crossref","unstructured":"Heredia NI , John JC , Singh S , et al . 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