Title: Challenges and needs in the management of non-alcoholic fatty liver disease from the
perspective of gastroenterology and hepatology specialists: a qualitative study
Version: 3 Date: 22 Jan 2025
Reviewer:  Maurizio Gaetano Polignano
Reviewer's report:
As I said in my last review, this article is interesting because it looks at the challenges and needs
of managing non-alcoholic fatty liver disease (NAFLD) from the point of view of specialists in
gastroenterology and hepatology in Iran. The strengths of the work include:
1. Qualitative approach: The study uses semi-structured interviews, allowing for a detailed
understanding of the experiences and perceptions of specialists, which are often overlooked in
quantitative studies.
2. It covers a wide range of topics and looks at clinical, social, economic and cultural aspects,
giving a full picture of the problem.
3. Practical implications: The results offer useful insights for policymakers and clinicians. They
suggest that a multidisciplinary approach should be adopted, and that digital technologies and
standardised protocols should be used.
4. Originality: I can't find any other similar studies, so I think this is the first qualitative study
in Iran on this topic so it helps to fill a gap in the local scientific literature.
But has also some weaknesses:
1. Small sample size: The study includes only 15 specialists, which limits how much the results
can be generalized.
2. There is a lack of views from different healthcare professionals (e.g. nutritionists,
psychologists). This means the analysis is not as complete as it could be.
3. Specific context: The results are strongly influenced by the Iranian context, with challenges
related to the healthcare system and socioeconomic conditions, which may limit applicability
in other countries.
4. No patient interviews: We didn't interview patients, so we don't know what they think.
It is easy to understand the difficulties of treating NAFLD in countries where healthcare is not
widely available, and the cultural barriers that make it difficult to manage the disease. In the
end, I think the paper is interesting, although it has the limitations mentioned above. I would
like to invite the authors to explore the issue from other perspectives (patients, other health
professionals) in future scientific articles.
Title: Challenges and needs in the management of non-alcoholic fatty liver disease from the
perspective of gastroenterology and hepatology specialists: a qualitative study
Version: 3 Date: 22 Jan 2025
Reviewer:  Maurizio Gaetano Polignano
Reviewer's report:
As I said in my last review, this article is interesting because it looks at the challenges and needs
of managing non-alcoholic fatty liver disease (NAFLD) from the point of view of specialists in
gastroenterology and hepatology in Iran. The strengths of the work include:
1. Qualitative approach: The study uses semi-structured interviews, allowing for a detailed
understanding of the experiences and perceptions of specialists, which are often overlooked in
quantitative studies.
2. It covers a wide range of topics and looks at clinical, social, economic and cultural aspects,
giving a full picture of the problem.
3. Practical implications: The results offer useful insights for policymakers and clinicians. They
suggest that a multidisciplinary approach should be adopted, and that digital technologies and
standardised protocols should be used.
4. Originality: I can't find any other similar studies, so I think this is the first qualitative study
in Iran on this topic so it helps to fill a gap in the local scientific literature.
But has also some weaknesses:
1. Small sample size: The study includes only 15 specialists, which limits how much the results
can be generalized.
2. There is a lack of views from different healthcare professionals (e.g. nutritionists,
psychologists). This means the analysis is not as complete as it could be.
3. Specific context: The results are strongly influenced by the Iranian context, with challenges
related to the healthcare system and socioeconomic conditions, which may limit applicability
in other countries.
4. No patient interviews: We didn't interview patients, so we don't know what they think.
It is easy to understand the difficulties of treating NAFLD in countries where healthcare is not
widely available, and the cultural barriers that make it difficult to manage the disease. In the
end, I think the paper is interesting, although it has the limitations mentioned above. I would
like to invite the authors to explore the issue from other perspectives (patients, other health
professionals) in future scientific articles.
Please review this paper.
user
Title: Challenges and needs in the management of non-alcoholic fatty liver disease from the
perspective of gastroenterology and hepatology specialists: a qualitative study
Version: 3 Date: 22 Jan 2025
Reviewer:  Maurizio Gaetano Polignano
Reviewer's report:
As I said in my last review, this article is interesting because it looks at the challenges and needs
of managing non-alcoholic fatty liver disease (NAFLD) from the point of view of specialists in
gastroenterology and hepatology in Iran. The strengths of the work include:
1. Qualitative approach: The study uses semi-structured interviews, allowing for a detailed
understanding of the experiences and perceptions of specialists, which are often overlooked in
quantitative studies.
2. It covers a wide range of topics and looks at clinical, social, economic and cultural aspects,
giving a full picture of the problem.
3. Practical implications: The results offer useful insights for policymakers and clinicians. They
suggest that a multidisciplinary approach should be adopted, and that digital technologies and
standardised protocols should be used.
4. Originality: I can't find any other similar studies, so I think this is the first qualitative study
in Iran on this topic so it helps to fill a gap in the local scientific literature.
But has also some weaknesses:
1. Small sample size: The study includes only 15 specialists, which limits how much the results
can be generalized.
2. There is a lack of views from different healthcare professionals (e.g. nutritionists,
psychologists). This means the analysis is not as complete as it could be.
3. Specific context: The results are strongly influenced by the Iranian context, with challenges
related to the healthcare system and socioeconomic conditions, which may limit applicability
in other countries.
4. No patient interviews: We didn't interview patients, so we don't know what they think.
It is easy to understand the difficulties of treating NAFLD in countries where healthcare is not
widely available, and the cultural barriers that make it difficult to manage the disease. In the
end, I think the paper is interesting, although it has the limitations mentioned above. I would
like to invite the authors to explore the issue from other perspectives (patients, other health
professionals) in future scientific articles.
assistant