Real-world management of non-alcoholic steatohepatitis differs from clinical practice guideline recommendations and across regions

•Reference guidelines exist for the diagnosis and management of patients with NASH.•This analysis compared reference guidelines and real-world practice in 3 regions.•Substantial deviations from reference guidelines were seen in testing and treatment.•Referral to diet, exercise, and lifestyle specialists was suboptimal.•Establishment, awareness, and adherence to national guidelines is needed.