Diagnostic and therapeutic decisions of general practitioners in patients with suspected or diagnosed non-alcoholic fatty liver disease with reference to current European guidelines

Objective
The aim of the multicenter study was to assess the compliance of diagnostic and therapeutic decisions of general practitioners in patients with suspected or diagnosed non-alcoholic fatty liver disease (NAFLD) with current guidelines of the European Association for the Study of the Liver, the European Association for the Study of Diabetes and the European Association for the Study of Obesity.

Material and methods
The multicenter survey was performed nation-wide by 844 general practitioners among 20,550 outpatients suspected for or already diagnosed with NAFLD (48.2%) during a routine visit. The lack of oral consent to participate and the inability to obtain answers to the survey questions were the only exclusion criteria.

Results
In the group suspected for NAFLD, activity of liver enzymes and ultrasound were ordered in 48.3% and 54.7% of patients. Among non-diabetic patients already diagnosed with NAFLD fasting glucose level was measured in 75.7%, an oral glucose tolerability test was performed in 38.7%, fasting insulin level was measured in 15.1%, and HOMA-IR was calculated in 5.5%. In the therapy the following were recommended: reduction of diet energy by 500-1000 kcal corresponding to the patient’s needs (in 40.9% and 87.2% suspected and diagnosed with NAFLD, respectively), restriction of the consumption of animal fat (in 45.1% and 93.7%) and alcohol (in 39.2% and 80.7%), increase in the consumption of complex carbohydrates (in 28.6% and 62.9%), avoidance of drinks and foods rich in fructose (in 32.4% and 71.5%), regular aerobic physical activity 150-200 minutes per week (in 39.2% and 82.5%) and regular resistance training (in 14.4% and 31.5%). Pharmacological treatment of concomitant diseases was prescribed in 38.7% and 73.4% of patients, respectively, including pharmaceutical products containing the necessary phospholipids (in 13.6% and 36.0%) and thiazolidine carboxylic acid (in 29.2% and 74.9%).

Conclusions
1. Polish general practitioners too rarely perform a diagnostic test for NAFLD and recommend changes in diet and physical activity, and too rarely perform tests for carbohydrate metabolism disturbances. 2. Diagnostic workup and NAFLD therapy are in line with the current guidelines.