Knowledge and management of metabolic dysfunction-associated steatotic liver disease among endocrinologists in Spain.

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease and is closely associated with type 2 diabetes mellitus (T2DM) and obesity. However, it continues to have limited clinical visibility outside the field of Hepatology.

OBJECTIVE

To evaluate knowledge, liver fibrosis screening practices, and perceived barriers related to MASLD among endocrinologists in Spain.

MATERIALS AND

METHODS

An exploratory cross-sectional observational study was conducted using an online survey promoted by the MASLD Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) and addressed to all society members. A total of 210 anonymized surveys were analyzed, collecting information on: liver fibrosis screening in patients with T2DM and/or obesity, diagnostic tools used, availability of clinical protocols, access to liver elastography, and the main barriers to MASLD management. A descriptive analysis of the results was performed.

RESULTS

Approximately half of the endocrinologists reported performing liver fibrosis screening in patients with T2DM or obesity. FIB-4 was the most frequently used screening tool (78.4%), although automated calculation was available in only 60.8% of centers. Lack of time, insufficient training, and limited protocol availability (31.6%) were identified as the main barriers, and direct access to elastography from Endocrinology departments was limited.

CONCLUSIONS

This exploratory study shows that MASLD is not yet fully integrated into endocrinology practice in Spain. The lack of systematic screening, together with organisational and educational barriers, limits the early detection of hepatic fibrosis in high-risk populations. Strengthening awareness, training, and protocol development is necessary to integrate liver health into the comprehensive management of patients with metabolic disease.