Non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH), are highly prevalent in Italy, with significant variation across regions. This real-world study of 380 Italian patients with NASH or suspected NASH revealed a high burden of obesity (81%) and type 2 diabetes (62%), with most patients managed by gastroenterologists or endocrinologists. Diagnosis commonly relied on ultrasonography, while liver biopsy and VCTE were performed in fewer than half of cases. Despite guideline recommendations for non-invasive fibrosis assessments like FIB-4 and ELF, their usage remained very low. Notably, patients managed by endocrinologists were more frequently referred by primary care physicians (PCPs), likely due to the overlap with diabetes management, while gastroenterologist referrals from PCPs were less common.

Treatment practices appeared suboptimal, with fewer than 15% of patients receiving vitamin E, pioglitazone, or GLP-1 receptor agonists, despite guideline support. Statins were prescribed to about one-third of patients, though concerns about their use in NAFLD persist despite evidence supporting cardiovascular and hepatic benefits. Physicians cited a lack of approved therapies and patient reluctance as reasons for limited intervention. Liver biopsy was often avoided due to invasiveness and the absence of approved treatments. Overall, the study underscores the need for better implementation of national guidelines, increased use of non-invasive diagnostics, and multidisciplinary collaboration to improve identification and management of NASH in Italy.

Reference: Bugianesi E, Miele L, Donnarumma G, et al. Non-Alcoholic Steatohepatitis Patient Characterization and Real-World Management Approaches in Italy. Pragmat Obs Res. 2024 Oct 10;15:185-200. doi: 10.2147/POR.S472468. PMID: 39403308; PMCID: PMC11472768.