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