1075 Primary Care and Specialty Physician Perspectives on Non-Alcoholic Fatty Liver Disease (NAFLD) Screening, Diagnosis, and Referral

Document Type


Publication Date


Publication Title

The American Journal of Gastroenterology



Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the developed world. It is associated with cardiovascular risks, malignancy and poor health-related quality of life. It is often under-recognized and undertreated by primary care providers (PCPs), leading to increased morbidity and mortality. Our study aims to assess PCP awareness of NAFLD risk factors, diagnosis and treatments, as well as their referral patterns to specialty care.


An anonymous provider survey was developed by 2 hepatologists, to assess PCPs’ perspectives on NAFLD disease knowledge, diagnosis, management, and referral of patients to sub-specialty care. Primary care and sub-specialty providers from Internal Medicine, Medicine-Pediatrics, Family Medicine, Geriatrics, Cardiology and Endocrinology, who spend >25% of their time in adult clinical care, were included. Descriptive statistics (means for continuous data, percentages for categorical data) were used.


A total of 438 physicians completed the survey: 83 Michigan Medicine, 18 Beaumont Health and 337 ACP physicians. 99.5% physicians reported most/some of their patients likely have NAFLD, while 19% strongly agreed to the role of screening for NAFLD. Most common associated comorbidities identified by PCPs were diabetes, obesity and hyperlipidemia. Comorbidities prompting screening most often were NAFLD family history, diabetes, and obesity. Hepatic function tests and liver ultrasound were the most frequently used screening tools. Only 22.6% of providers used non-invasive serum-based staging, and 23% used fibroscan. 67% providers referred few/none of their patients to specialists, with mainly advanced fibrosis/cirrhosis patients being referred. Most common barriers to PCP NAFLD evaluation and treatment included uncertainty of NAFLD treatments (47.3%) and low priority (30.8%). 74% providers reported no change in statin prescription.


Despite the high rates of NAFLD in primary care, the rate of NAFLD screening and referral to specialty care is surprisingly low. Additionally, non-invasive tests for staging hepatic fibrosis are underutilized, which means that high-risk NAFLD patients with advanced fibrosis are likely overlooked. Important barriers to be addressed include improving NAFLD recognition, as well as disease assessment and knowledge of NAFLD treatment. Emphasis should be placed on early referral before patients reach advanced cirrhosis.



First Page


Last Page