Poor Awareness of Liver Disease Among Adults With NAFLD in the United States

Abstract

Population-based studies that estimate awareness of nonalcoholic fatty liver disease (NAFLD) in the United States are scant. We aimed to understand public awareness of NAFLD and its temporal trends. Our study included 11,700 adults (18+ years old) from five National Health and Nutrition Examination Surveys (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016). NAFLD was determined by the improved Fatty Liver Index for the multiethnic U.S. population (US-FLI) in the absence of secondary causes of liver disease. Overall prevalence of NAFLD, hepatitis C virus, and hepatitis B virus were 36.6%, 1.02% and 0.35%, respectively. From 2007-2008 to 2015-2016, awareness of liver disease among adults with NAFLD improved from 4.4% to 6.3% (trend P = 0.026) but 4 to 10 times lower than awareness about viral hepatitis. In 2015-2016, among adults with NAFLD, awareness of liver disease was lower among young adults (aged 18-29 years) compared with those aged ≥ 30 years (0% vs. 6.9%) and lower among non-Hispanic Blacks compared with other races (0.7% vs. 6.6%) (all P < 0.001). In multivariable analysis, young adults (adjusted odds ratio [aOR] = 0.29; confidence interval [CI] 0.10-0.87) and non-Hispanic Blacks (aOR = 0.43; CI 0.20-0.96) were negatively associated with awareness of liver disease among adults with NAFLD, whereas diabetes (aOR = 2.22; CI 1.37-3.58), advanced fibrosis (aOR = 2.34; CI 1.17-4.68), and a higher number of health care visits (aOR = 1.33; CI 1.15-1.50) were positively associated with awareness of liver disease. Nearly 96% of adults with NAFLD in the United States were unaware they had liver disease, especially among young adults and non-Hispanic Blacks. Findings indicate efforts are needed to improve awareness of NAFLD. (Hepatology Communications 2021;0:1-15).

Internet search engines and social media are improving awareness on non-alcoholic fatty liver disease in Brazil

“…In addition, more than half of the participants were in agreement that fatty liver could lead to diabetes, cirrhosis, myocardial infarction and/or stroke and cancer. Those findings regarding population knowledge about NAFLD were much better than those previously 3,4 reported and demonstrated a higher than average awareness level of the Brazilian population toward the burden of NAFLD. This may be due to previous campaigns conducted by IBRAFIG and other organizations to improve disease awareness or possibly the effect of social media increasing public interest about this subject.…”

Living in the non‐alcoholic fatty liver disease silent epidemic: a qualitative systematic review of patients' perspectives

“…Compared to other NCDs, there is a severe lack of awareness of NAFLD by the general population and healthcare providers 3,11 . A recent analysis by Lazarus et al on the global preparedness of NAFLD, a third of countries scored 0 on the preparedness index and no countries had a comprehensive public health response for NAFLD 12 .…”

Prepandemic prevalence estimates of fatty liver disease and fibrosis defined by liver elastography in the United States

“…Liver disease awareness has improved little from previous reports in the U.S. population using earlier NHANES data in which NAFLD was identified by liver fat scores. 41 Fatty liver disease may remain asymptomatic and not come to expert medical attention until reaching an advanced stage.…”

“…Liver disease awareness has improved little from previous reports in the U.S. population using earlier NHANES data in which NAFLD was identified by liver fat scores. 41 Fatty liver disease may remain asymptomatic and not come to expert medical attention until reaching an advanced stage. However, despite the current lack of an approved pharmacologic therapy, persons identified early with fatty liver disease can benefit from recommendations for diet and exercise for weight loss, as well as treatment of cardiovascular disease risk factors.…”