Management Concepts of Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) Among Chinese Physicians

The reason for severity assessment will be measured via questionnaires. The corresponding questionnaire items were designed to explore whether physicians would conduct further evaluation for patients diagnosed with MASLD and what dimensions such further evaluation would cover. Details of the questions are shown below:

1. For patients with confirmed MASLD, will you perform additional diagnostic evaluation? (Single choice)

   • Yes, I will conduct subsequent assessment and risk stratification
   • No, a confirmed MASLD diagnosis is sufficient.

2. For physicians who selected "Yes": What dimensions will your additional diagnostic evaluation cover? (Multiple choices)

   • Rule out other liver diseases
   • Assess metabolic comorbidities and risk factors
   • Identify whether the patient has concurrent MASH
   • Determine the stage of liver fibrosis
   • Others, please specify

Methods used for liver fibrosis diagnosis will be assessed via questionnaires. The corresponding questionnaire items asked physicians to select the examinations they use to assess the stage of liver fibrosis in patients with MASLD.

For physicians who perform liver fibrosis staging: Among patients with confirmed MASLD, which of the following tools do you use in routine clinical practice to evaluate liver fibrosis stage? Available response options include FibroScan, FibroTouch, Magnetic Resonance Elastography (MRE), fibrosis-specific serological tests (e.g., PIIINP, C-IV, LN, HA), simple scoring systems (e.g., FIB-4, NFS, APRI), and others (please specify).

Percentages of patients who undergo different liver fibrosis examination will be measured via questionnaires. The corresponding questionnaire items asked physicians to report the proportion of patients with MASLD for whom they utilize each liver fibrosis assessment method in routine clinical practice.

For each selected examination tool, physicians report the proportion of patients receiving the test in their daily clinical work using predefined categories (≤10%, 10%-25%, 25%-50%, 50%-75%, and 75%-100%).

This will be assessed via questionnaires. The corresponding questionnaire items investigate whether physicians believe there is insufficient liver fibrosis assessment in current clinical practice. Those who answer affirmatively are then asked to select contributing factors.

For patients with confirmed MASLD, physicians are asked: do you think liver fibrosis assessment is currently inadequate in clinical practice? If yes, what are the leading causes of insufficient fibrosis evaluation? Physicians can select from predefined causes, including clinicians paying insufficient attention to liver fibrosis evaluation, low patient acceptance rate of liver biopsy, low diagnostic accuracy of existing noninvasive fibrosis assessment tools, lack of effective pharmacotherapies for liver fibrosis, and others (please specify). There is also an option indicating that there is no inadequate liver fibrosis assessment in clinical practice, which is mutually exclusive with the other options.

This will be measured via questionnaires. The corresponding questionnaire items investigate whether physicians believe there is insufficient liver fibrosis assessment in current clinical practice. Those who answer affirmatively are then asked to rank the contributing factors in order of importance.

For the selected causes of insufficient fibrosis evaluation, physicians rank each factor based on its importance in contributing to inadequate liver fibrosis assessment in clinical practice.