Metabolic dysfunction-associated steatotic liver disease in primary care: an international Delphi consensus

Metabolic dysfunction-associated steatotic liver disease in primary care: an international Delphi consensus. The Lancet Primary Care.

 

Gong Feng, Shouping Gong, Frank Tacke, Luca Valenti, Mark Muthiah, Koki Kato, Zhaoxiang Yu, Giovanni Targher, Christopher D Byrne, Mohamed Farouk Allam, et al.

 

The Lancet Primary Care 2026; Online first 100205 September 02.

https://doi.org/10.1016/j.lanprc.2026.100205

 

Abstract:

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide, with general practitioners and family doctors (collectively referred to as GPs) playing a key role in its management. However, numerous challenges persist in primary care settings. We aimed to develop consensus statements and recommendations to support MASLD management in primary care through an international collaboration of multidisciplinary experts. Experts were selected on the basis of clinical and academic expertise, publication record, involvement in guideline or consensus work, and geographical representation. 51 experts from 30 countries across six continents participated in round 1, and 49 experts from 29 countries participated in round 2. The expert panel included hepatologists or gastroenterologists, GPs, endocrinologists, cardiologists, and experts from other relevant disciplines. Agreement rose from 1271 (73⋅3%) of 1734 in round 1 to 1119 (87⋅8%) of 1274 in round 2, yielding 26 consensus statements across six domains: use of screening and non-invasive diagnostic tools; referral pathways for individuals at risk of advanced fibrosis; treatment goals emphasising weight reduction, dietary modifications, physical activity, and metabolic risk control; structured follow-up based on dynamic changes in clinical and fibrosis indicators, with assessment of extrahepatic complications; the role of GPs in patient education, lifestyle interventions, and coordination of multidisciplinary care; and training frameworks and system-level support to enhance primary care capacity. This expert consensus provides a systematic guide for managing MASLD in primary care, emphasising the key role of GPs in early screening, patient education, and behavioural interventions. It also offers a practical management framework for primary care worldwide and provides essential guidance for future research and policy development.

 

Keywords: metabolic dysfunction-associated steatotic liver disease; metabolic dysfunction-associated fatty liver disease; primary care; family physicians, consensus.

 

https://www.thelancet.com/journals/lanprc/article/PIIS3050-5143(26)00101-9/fulltext

Sociodemographic factors of Environmental Enteropathy among Egyptian infants and children; A Retrospective Case–Control Study

Sociodemographic factors of Environmental Enteropathy among Egyptian infants and children; A Retrospective Case–Control Study

 

May Fouad Nassar (1), Ehab Khairy Emam (1), Mohamed Farouk Allam (2), Ahmed Mohamed Hamdy (3), Bassma A Abdelhaleem (1), Nehal Ahmed Radwan (4), Abeer Mohamed Emam (1), Haya Essam Ibrahim (1)

 

1. Department of Pediatrics, Pediatric Clinical Nutrition Unit, Faculty of Medicine, Ain Shams University, Egypt.

2. Department of Family Medicine, Faculty of Medicine, Ain Shams University, Egypt.

3. Department of Pediatrics, Pediatric Gastroenterology Unit, Faculty of Medicine, Ain Shams University, Egypt.

4. Department of Pathology, Faculty of Medicine, Ain Shams University, Egypt.

 

Clin Ter 2026; 177 (3):525-531. doi: 10.7417/CT.2026.2037

 

Abstract

 

Background. There is substantial evidence that nutritional rehabilitation does not effectively resolve growth faltering in low- and middleincome countries, suggesting that environmental enteropathy (EE) may be a key underlying factor. EE is a chronic, subclinical condition associated with poor environmental conditions and limited resources in these regions. It is marked by pathological changes in the small intestine that impair the absorption of both macronutrients and micronutrients, ultimately contributing to growth faltering.

Objective. to assess the sociodemographic factors underlying the EE among infants and children with faltering growth (FG) in our community.

Patients and methods. This retrospective case control study enrolled 200 cases of primary faltering growth infants and children aged from 6 months to 5 years old after exclusion of secondary cases. Enrolled patients were divided into refractory cases and responsive cases to nutritional rehabilitation programs and sociodemographic factors were assessed among the 2 groups. No routine endoscopy was done nor existing histopathology findings were available.

Results. The results of this study revealed that out of the 200 enrolled patients 170 responded to the tailored nutritional program (responsive controls), while 30 patients were considered as refractory cases. On comparing the two groups, there were significantly higher frequencies of housewife mothers, non-skilled manual worker fathers, rural and slum residency, and low socioeconomic status among the refractory cases with p-values of 0.024, 0.002, 0.022, and 0.045 respectively.

Conclusion. Malnutrition is a complex condition with multifactorial causes, including socioeconomic factors besides the deficiencies in protein, energy, and essential micronutrients. In developing countries, EE is recognized as a significant contributor to the burden of malnutrition percolating their response to the nutritional rehabilitation program. Non-responders to nutritional rehabilitation program should be referred for endoscopy to confirm the diagnosis of EE.

 

Keywords: Pediatric Malnutrition, Growth Faltering, Sociodemographic factors.

 

https://www.clinicaterapeutica.it/ojs/index.php/1/article/view/1555/1041