ADIPOSE
Research type
Research Study
Full title
Assessing awareness of fatty liver disease among people in Scotland: a cross-sectional survey study
IRAS ID
333685
Contact name
John Dillon
Contact email
Sponsor organisation
University of Dundee
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Summary of Research
Non-alcoholic fatty liver disease [NAFLD] (also known as Metabolic Dysfunction-Associated Steatotic Liver Disease [MASLD]) is a condition in which individuals with metabolic syndrome accumulate excess fat in their livers. In a small number of people with the condition, NAFLD/MASLD can result in liver cirrhosis (scarring) or liver cancer. Treatments for NAFLD/MASLD currently rely on it's early detection and lifestyle/ medication interventions to address risk factors such as obesity and Type 2 Diabetes [T2D]. As rates of obesity and metabolic syndrome rise, NAFLD/MASLD poses an increasingly significant public health threat, described as "a looming public health tsunami". However, it has been shown in people from the USA, China and elsewhere that individuals at risk of NAFLD/MASLD are not aware of the condition and it's risks, making early detection and effective lifestyle/medical intervention a challenge. We currently have no data on the extent of NAFLD/MASLD awareness in Scotland or the UK more broadly.The ADIPOSE study will survey people across Scotland to assess their awareness and knowledge of NAFLD/MASLD. We will survey those with risk factors for NAFLD/MASLD (T2D and cardiovascular disease [CVD]), as well as the general population. We will identify those with risk factors and members of the general population from throughout Scotland via The Scottish Health Research Register & Biobank [SHARE] platform. The SHARE team will contact people via email who have previously agreed to take part in research. The email will contain study information and a link to the ADIPOSE survey - including a consent form and questions about study participants awareness and understanding of NAFLD/MASLD.
ADIPOSE will help underpin future public health planning and relevant health interventions. Without understanding current awareness of NAFLD/MASLD, attempts to increase awareness and introduce effective preventative strategies (essential in the absence of medications to treat NAFLD/MASLD directly) will be less effective for people at risk.
Summary of Results
Metabolic dysfunction-associated steatotic liver disease [MASLD], which replaced non-alcoholic fatty liver disease [NAFLD], is a condition in which excess fat is stored in the liver. This can lead to irritation and inflammation in the liver and in some people, scarring in the liver. MASLD/NAFLD is the commonest liver disease globally and exists within the wider metabolic syndrome (metabolic syndrome includes obesity, type 2 diabetes, high cholesterol and high blood pressure). However, previous studies have shown that awareness of NAFLD/MASLD is low in both the general population and groups of people at-risk for the condition. However, so far no such awareness data exists for large UK populations and so we do not know how many people in the UK know about the condition.We conducted the 1st national survey assessing awareness and knowledge of “fatty liver disease” [FLD] (NAFLD/MASLD), among adults with both low and high risk of MASLD in Scotland.
Method:
Adults living in Scotland, registered with Scottish Health Research Register, were invited by email to complete an online survey on their awareness of liver disease.
Participants self-reported demographic and health information and their knowledge of NAFLD/MASLD and related conditions.
Participants were considered “at risk” for MASLD [AR] if they had ≥1 self-reported risk factor (Type 2 Diabetes/Cardiovascular Disease/Body Mass Index ≥25). Individuals with no risk factors were considered low risk [LR].
Analysis utilised descriptive statistics and chi-squared tests.Results:
From 01/07 - 23/09/24 19,763 people were invited to complete the survey.2,114 people (11%), representing all 14 Scottish Health Boards, completed the survey (1,227 [58%] female, 1,178 [56%] aged 60-79).
1,586 (75%) were AR (466 [22%] T2D; 474 [22%] CVD; 1325 [63%] BMI ≥25) and 528 (25%) were LR.
217 (10%) reported a diagnosis of “FLD, NAFLD or MASLD” - 200 [13%] AR, 17 [3%] LR (p <.001).1,495 (71%) knew of “fatty liver disease”, 810 (38%) of NAFLD and 99 (5%) of MASLD. Those AR were not significantly more likely to know of these conditions relative to LR respondents (p=.354; .349; .755, respectively). Significantly more women than men were likely to know of FLD (965 [79%], p=<.001) and NAFLD (588 [48%], p=<.001).
86% of respondents were aware of alcohol related liver disease, 75% of viral hepatitis and >90% of other metabolic syndrome features (T2D, hypertension, obesity).
After receiving information about the lack of medications for treating NAFLD/MASLD, 2,073 (98%) stated that if they had the condition, they would still wish to know.
Conclusion:
This national survey gives the first population-level insight into the awareness of NAFLD/MASLD in the UK. While many people report awareness of “fatty liver disease”, less than half are aware of NAFLD and only 5% of MASLD.Those individuals at highest risk are not more likely to know of these conditions compared to those at lower risk. However, significantly more of the at-risk group report a diagnosis of NAFLD/MASLD. This low NAFLD/MASLD awareness contrasts with a much higher awareness of other causes of liver disease (such as viral hepatitis or alcohol) and other features of the metabolic syndrome (such as high blood pressure, cholesterol or diabetes).
Almost all survey respondents stated that if they had MASLD they would want to be made aware of the diagnosis, even after it was explained that current management is largely lifestyle based.
This study clearly demonstrates the outstanding efforts that are necessary to increase population awareness of MASLD, one of the largest public health threats in the coming decades.
REC name
North of Scotland Research Ethics Committee 1
REC reference
24/NS/0029
Date of REC Opinion
13 Mar 2024
REC opinion
Favourable Opinion