Insights from qualitative research on NAFLD awareness with a cohort of T2DM patients: time to go public with insulin resistance?

Abstract

Background: It is estimated that around 70% of Type 2 Diabetes Mellitus patients (T2DM) have Non-Alcoholic Fatty Liver Disease (NAFLD). Awareness and education are amongst the major shortcomings of the public health response to the increasing threat of NAFLD. Characterizing the specific NAFLD-related information needs of particular high-risk metabolic communities, for instance, T2DM patients, might aid in the development of evidencebased health promotion strategies, ultimately promoting NAFLD-awareness, treatment adherence and therapeutic success rates. Methods: Semi-structured interviews with T2DM patients were conducted to gain insight into their awareness of NAFLD, including its relationship with insulin resistance and T2DM. Results: Awareness of NAFLD as a disease entity, as well as its progression to end-stage liver disease or its relationship with other metabolic conditions, including insulin resistance and T2DM was low. Surveillance behaviours were also suboptimal and perceptions on the self-management knowledge and praxis regarding lifestyle intervention components of T2DM treatment seemed detached from those of NAFLD. Conclusions: Our findings could inform the integration of NAFLD-related content in T2DM health promotion strategies. Rising awareness on NAFLD progression and its relationship with T2DM using culturally and communityrelevant constructs might facilitate the development of primary and secondary prevention programmes to promote the adherence to lifestyle interventions by influencing NAFLD threat perceptions.

Factors associated with engagement and adherence to a low-energy diet to promote 10% weight loss in patients with clinically significant non-alcoholic fatty liver disease

“…However, advice regarding weight loss for patients with NAFLD is often vague and unstructured and this was a finding of our previous work. 25 26 As such, clinicians may benefit from training to improve the information they provide to patients to maximise the likelihood of behavioural change by targeting facilitators of behavioural intention including outcome expectancies and risk perceptions. 25 26 Generally, awareness of NAFLD is low, even in populations at highest risk, 27 28 therefore it is likely that knowledge about the role of weight loss on prevention of progression of NAFLD is lacking.…”

From nonalcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease: is it time for a change of terminology?

“…Furthermore, the term "nonalcoholic" over-emphasizes the absence of significant alcohol consumption and does not acknowledge the importance of overweight/obesity, type 2 diabetes mellitus, insulin resistance and other metabolic risk abnormalities that fuel the risk of liver disease progression and the development of serious adverse extrahepatic outcomes (e.g., cardiovascular disease, extra-hepatic malignancies or chronic kidney disease) [36][37][38][39][40][41] . To date, it is known that there is a substantial under-appreciation of NAFLD by both primary care clinicians and patients [42,43] . We believe that the proposed change of the name from NAFLD to MAFLD holds promise to aid in increasing awareness of this liver disease and decreasing its possible social stigma due to its link to alcohol intake.…”

Differences between current clinical guidelines for screening, diagnosis and management of nonalcoholic fatty liver disease and real-world practice: a targeted literature review

“…Patients with significant risk factors for NAFLD repeatedly report low levels of awareness of potential liver disease [55][56][57][58][59]. A recent study of awareness around NAFLD among 30 patients with T2DM revealed that just half were familiar with the concept of 'fatty liver' [58]. Although disease awareness among patients with NAFLD was found to be low, it has increased slightly over the past two decades [57].…”