Inadequate identification of fatty liver disease, obesity, and metabolic syndrome by family physicians

Abstract

Mahmud Mahamid,1–3,* Tawfik Khoury,1,* Hana Amara,1 Mahmoud Siadi,1,3 Jabaren Mohamed,4 Amir Mari,1 Rafea Shalabi,5 Hisham Sholy,6 Wiliam Nseir3 1Gastroenterology and Liver Diseases Unit, EEMS, The Nazareth Hospital, Nazareth, Israel; 2Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; 3Division of Internal Medicine, EMMS, The Nazareth Hospital, Nazareth, Israel; 4Cardiology Department, HaEmek Medical Center, Afula, Israel; 5Department of Internal Medicine, The Baruch Padeh Medical Center, Poriya, Israel; 6Liver Unit, Rambam Health Campus, Haifa, Israel *These authors contributed equally to this work Background: Nonalcoholic fatty liver disease (NAFLD) is an emerging condition and is constituted as a vital public health epidemic globally. This study evaluated the process of identification and documentation of NAFLD and metabolic syndrome in correlation with those diagnosed with obesity. Methods: Participants included 352 patients older than 18 years who were diagnosed with fatty liver disease. We performed a cross-sectional study between August 2016 and September 2017. Categorical variables were extracted and analyzed using SPSS. The body mass index (BMI) was determined by the study staff and compared with the data retrieved from the family physician’s database. Results: Patients who presented documented BMI in their past medical history showed to be significantly higher than those without documentation of BMI (29+4.4 vs 25.7+4.6 kg/m2, P<0.01). For instance, 54% of patients with NAFLD were documented in the electronic medical record (EMR) by the family physician, with higher documentation rate among males than females. Moreover, 72% qualified for documentation of metabolic syndrome, but only 5% were documented in their EMR. Patients with significant obesity and obesity-related conditions were more likely to have documentation in their EMR. Discussion: Further analyses supported the conclusion that family physicians inadequately identify BMI in the EMR for overweight, obesity, metabolic syndrome, and fatty liver disease. Additional efforts are necessary to improve knowledge of proper identification of NAFLD and metabolic syndrome. Keywords: metabolic syndrome, family physician, obesity, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis

Keywords

• metabolic syndrome
• family physician
• obesity
• non-alcoholic fatty liver disease
• non-alcoholic steatohepatitis