Development of an evaluation framework for a lifestyle management model among Chinese MASLD patients under the concept of physical and medical integration.

OBJECTIVE: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), has emerged as a significant public health threat in China. Under the national "physical and medical integration" framework-which advocates collaborative efforts between healthcare and sports science-there is an urgent need to develop a scientific and practical evaluation system to standardize lifestyle management programs for MASLD patients and support clinical implementation of evidence-based lifestyle interventions.

METHODS: Building on prior research identifying factors influencing adherence to healthy lifestyles among Chinese MASLD patients, we employed a mixed-methods approach combining in-depth interviews and a two-round Delphi survey with experts from exercise science, public health, health management, exercise prescription for chronic diseases, and hepatology. The Analytic Hierarchy Process (AHP) was used to determine indicator weights and finalize the evaluation framework.

RESULTS: Six experts participated in in-depth interviews, and 12 experts completed two rounds of Delphi questionnaires (response rates: 100% and 91.7%; authority coefficients: 0.90 and 0.89). The final evaluation system comprises three dimensions: (1) Process evaluation-6 first-level indicators (e.g., organizational structure, personnel configuration, supporting facilities) with 12 second-level indicators; (2) Effect evaluation-3 first-level indicators (patient participation, lifestyle improvement, follow-up status) with 5 second-level indicators; and (3) Outcome evaluation-2 first-level indicators (disease control, health-related physical fitness improvement) with 4 second-level indicators. Kendall's W coefficients indicated statistically significant consensus (first-level: 0.23 and 0.20; second-level: 0.22 and 0.26; all P < 0.05). AHP-derived weights were 0.50 for process, 0.25 for effect, and 0.25 for outcome. All consistency ratios (CR) were below 0.1, confirming the validity of the weighting.

CONCLUSION: This study successfully developed a multidimensional, reliable, and practice-oriented evaluation system for lifestyle management of MASLD patients under the integration of medicine and physical activity framework. The system provides a standardized tool to assess and improve the quality of integrated lifestyle interventions in clinical settings, offering actionable guidance for delivering coordinated, patient-centered care for MASLD.