Comment:
The association between metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD) has been well-characterised by recent literature. As such, patients with NAFLD are disproportionately affected by a range of comorbidities, which include obesity, dyslipidemia, type 2 diabetes mellitus (T2DM), and hypertension. A multidisciplinary and multistakeholder approach is thus required to deliver comprehensive care to this patient population. However, while a wide range of models of care (MoCs) for NAFLD currently exist, national management plans are deficient globally. This reflects systemic gaps in the delivery of NAFLD care and a lack of coordination across national healthcare systems.
The aim of this article was to summarise the discussions for a May 2022 multidisciplinary meeting addressing public health approaches for both NAFLD and non-alcoholic steatohepatitis (NASH).
Key learnings:
To assess the patient benefit and cost-effectiveness of multidisciplinary MoCs, non-invasive tests should be administered by first-line providers and their use should be closely monitored. Context- (prevention, screening, risk-stratification, treatment) and resource-specific (for low-, middle- and high-income settings) MoCs should also be implemented and evaluated. Furthermore, clear guidance should be provided regarding preventive hepatology, and the precise criteria for referral to specialist care should be defined. Lastly, to overcome the time constraints of primary care physicians, human burdens should be alleviated where possible. Promising strategies to do so include automated methods of screening, multidisciplinary metabolic clinics, and virtual care. Implementing these recommendations may guide the development of effective multidisciplinary MoCs for NAFLD.
