objective

Assess needs & initiatives that will eliminate barriers and gaps experienced by Hepatologists & Gastroenterologists in the diagnosis and management of NAFLD/NASH and share the results in the form of a INDIA specific NASH Action plan, with the entire fraternity for future collaborative efforts by all stakeholders including HCPs, Societies, Advocacy Groups and Industry.

a

Pre survey profiling.

1Please rate your expertise with NAFLD & NASH. Answer for your speciality only.

Familiarity with NAFLD

Speciality Somewhat Very Extremely
Hepatology
Gastroenterology
Physician

Familiarity with NASH

Speciality Somewhat Very Extremely
Hepatology
Gastroenterology
Physician

2What is the primary nature of your practice?

3No of NAFLD Patients seen weekly

4What is your perception on NAFLD & NASH?

Perception Strongly Disagree Disagree Agree Strongly Agree
NASH should not be ignored because it will impact our health system dramatically in the next few years.
It is a frustrating condition because there are few approved treatment options in India
Once effective therapeutic treatments are found, I will be more likely to screen for NASH
Once effective therapeutic treatments are found, I will be more likely to diagnose NASH.
Once effective therapeutic treatments are found, I will be more likely to treat NASH.

b

NAFLD/ NASH Awareness

5What is your primary source for knowledge on NAFLD & NASH? Select all that apply.

6To the best of your knowledge which of the following best defines NAFLD. Please select one.

7To the best of your knowledge which of the following best defines NAFL (Non Alcoholic Fatty Liver). Please select one.

8To the best of your knowledge which of the following best defines NASH (Non Alcoholic SteatoHepatitis). Please select one.

9What proportion of following subjects is likely to have NAFLD

Subject group Almost all Upto 75% Upto 50% Upto 25% Can't say
General Population
Subjects with Type 2 diabetes
Subjects with severe obesity
Subjects with Dyslipidaemia
Subjects with Hypertension
Subjects with PCOS
Subjects with family history of NAFLD
Subjects with Cryptogenic Liver Disease
Combination of two or more risk factors

10Which of the following statements is less likely?

c

NAFLD / NASH Screening

11What is the reason for not screening NAFLD / NASH regularly (if applicable). Select all that apply

12 Which patient groups should be screened regularly for NAFLD & NASH?

Subject group Yes No Would need more info to decide
Subjects with abnormal LFTS
Subjects with Type 2 Diabetes
Subjects with Obesity
Subjects with Dyslipidaemia
Subjects with Hypertension
Subjects with family history of NAFLD
Subjects with PCOS

13What is your initial Assessment in patients with NAFLD/Suspected NAFLD .

Initial Evaluation Yes No Would need more info
To look for raised Liver Enzymes
To look for presence of metabolic risk factors and metabolic syndrome.
Exclusion of other Liver Diseases
Ultrasound abdomen
Fibroscan
> CAP
> LSM
CT Scan
MRI/MR-PDFF
Other non-invasive assessment with all or either of the three
> APRI
> FIB-4
> NFS
Liver Biopsy

14Which methods are available in your practice for the diagnosis of NAFLD/NASH? Select all that apply

15What are your preferred methods to approach non-invasive diagnosis of steatohepatitis and significant/advanced fibrosis in NAFLD? Rate with 10 being most preferred , 1 being least preferred

Method Rating
Liver Enzymes/ AST ALT Ratio
APRI, FIB4, NFS, BAARD
Abdominal Ultrasound
Elastography ( Fibroscan / SWE)
CT Scan
MRI / MRE

16Would you recommend routine surveillance for HCC in patients with Non Cirrhotic NASH

17What are your indications for liver biopsy in NAFLD ?

Liver Biopsy Considerations Yes No Would need more info
Presence of metabolic risk factors or metabolic syndrome
Persistent elevation of ALT
Non-invasive assessment suggestive of significant/advanced fibrosis
Co-existence of other liver diseases
Only as a part of clinical trials
In children before starting pharmacotherapy
Others – please elaborate

D

NAFLD/ NASH Patient Management

18How do you counsel your patients with NAFLD / NASH regarding a healthy lifestyle?

19Which of the following advice is given to patients with NAFLD & NASH?

Advise to Patients Yes No Would need more info
Avoid Heavy Alcohol consumption
Good control of diabetes, hypertension and dyslipidemia
Weight reduction in those with overweight and obesity
Reduction in calorie intake
Specific Diet accompanied with diet chart
Structured exercise program
Only aerobic exercises
Aerobic or anaerobic exercises
Any number of hours of exercise, at least 150 minutes/week

20Which of the following diets you usually recommend to NAFLD / NASH patients? Select All That Apply

21Do you have diet charts to be handed over to patients? Select All That Apply

22which patient related barriers for NAFLD & NASH management do you face? Select All That Apply

23Do you feel that awareness through mass media such as Print, Radio, TV is effective and needed in disseminating information about NAFLD & NASH to general population?

24Please rate the following media in order of their effectiveness for spreading NAFLD awareness

Medium Not Effective Somewhat Effective Effective Very effective
1 - 1 interaction with doctor
In clinic awareness programs
Public Forums
Newspapers / Magazines
Radio
Television channels
Social Media

e

NAFLD/ NASH Treatment

25In the absence of FDA approved treatments, do you currently use pharmacotherapy for NASH ?

26Which pharmacotherapy options do you prefer? Select all that apply.

f

NAFLD/ NASH Legislative / Policy

27On a scale of 1-5 how would you rate the preparedness of our healthcare system pertaining to NAFLD & NASH

Parameter Rating
Surveillance of NAFLD & NASH
Regulatory prioritization
Community based preventive efforts
Medical Infrastructure
Reimbursement Policies

28Has the recent inclusion of NAFLD in the NPCDCS guidelines had any impact in your practice?