Rev Esp Enferm Dig. 2026 Jun 10. doi: 10.17235/reed.2026.12002/2026. Online ahead of print.
ABSTRACT
Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a systemic condition that extends beyond the liver and closely intersects with the cardiovascular-kidney-metabolic spectrum. However, this pathophysiological understanding contrasts with a fragmented model of care in which Primary Care and Gastroenterology/Hepatology often approach the same disease from partially disconnected perspectives. Two recent Spanish surveys illustrate this gap: specialists in Gastroenterology/Hepatology show strong awareness of fibrosis as the main prognostic determinant and broad access to elastography, whereas Primary Care physicians display a more robust cardiometabolic perspective but more limited access to liver risk stratification tools and structured referral pathways. This divergence should not be interpreted as a failure of either level of care, but as the consequence of organizational models that do not reflect the systemic nature of MASLD. In the era of emerging disease-modifying therapies, fragmented care may contribute to diagnostic delay, missed opportunities for early intervention, and inequitable access to treatment. We therefore propose a practical integrated care pathway linking Primary Care and Hepatology through six sequential stages: identification of at-risk individuals, case-finding in at-risk populations using emerging risk scores, FIB-4 as the first non-invasive step, second-step stratification with elastography or ELF, specialist confirmation and therapeutic decision-making, and longitudinal follow-up. A parallel multidisciplinary axis involving Endocrinology, Cardiology, Nephrology, Internal Medicine and lifestyle/mental health support is essential across all stages. Integrating these perspectives into shared, protocolized care pathways is necessary to improve identification, risk stratification, and long-term management of patients with MASLD.
PMID:42267427 | DOI:10.17235/reed.2026.12002/2026