article · The Lancet Primary Care
Metabolic dysfunction-associated steatotic liver disease is the most common chronic liver disease globally, presenting major management challenges in primary care. To address these difficulties, an international Delphi consensus process engaged multidisciplinary experts from up to thirty countries, including general practitioners, hepatologists, endocrinologists, and cardiologists. Across two consultation rounds, panel agreement reached 87.8 per cent, generating twenty-six consensus statements structured across six operational domains. These areas encompass the deployment of screening and non-invasive diagnostic tools, established referral pathways for individuals at risk of advanced fibrosis, and treatment targets focused on weight reduction, diet, exercise, and metabolic risk control. The recommendations also define structured follow-up protocols, emphasise the central role of general practitioners in patient education and care coordination, and detail training frameworks alongside system-level support needed to build primary care capacity worldwide.
Metabolic dysfunction-associated steatotic liver disease affects large populations worldwide, yet primary care providers frequently face obstacles in diagnosis and ongoing management. Establishing clear, internationally agreed recommendations helps standardise early screening, lifestyle guidance, and specialist referral criteria. This coordinated approach supports family doctors in identifying high-risk patients earlier, preventing severe liver damage and associated complications through practical, structured interventions in primary care settings.
The consensus statements provide an applied framework for healthcare organisations, professional bodies, and primary care providers. While not a commercial technology, the guidance is near-market in terms of operational use, offering immediate utility for health systems designing clinical decision-support tools, diagnostic algorithms, and standardised training programmes for metabolic liver disease management.
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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.
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DOI: 10.1016/j.lanprc.2026.100205
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