Journal of General Internal Medicine

, Volume 34, Issue 12, pp 2772–2778 | Cite as

Low Awareness of Nonalcoholic Fatty Liver Disease in a Population-Based Cohort Sample: the CARDIA Study

  • Erin R. Cleveland
  • Hongyan Ning
  • Miriam B. Vos
  • Cora E. Lewis
  • Mary E. Rinella
  • John Jeffrey Carr
  • Donald M. Lloyd-Jones
  • Lisa B. VanWagnerEmail author
Original Research



Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States, yet little is known about NAFLD awareness in individuals with incidental fatty liver on imaging.


To assess the level of awareness of imaging-defined NAFLD among individuals with and without metabolic risk factors.


Cross-sectional analysis within a prospective longitudinal population-based cohort study conducted in four U.S. cities.


Adults age 43 to 55 years enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study who underwent computed tomography and a personal health questionnaire at the year 25 exam (2010–2011, n = 2788).

Main Measures

NAFLD was defined as liver attenuation ≤ 51 Hounsfield units after exclusion of other causes of liver fat. Participants were considered “NAFLD aware” if they reported being told previously by a doctor or nurse that they had “fatty liver.”

Key Results

NAFLD prevalence was 23.9%. Only 16 of 667 (2.4%) participants with CT-defined NAFLD were aware of a NAFLD diagnosis. NAFLD aware participants were more likely to be white (81.3% vs. 53.5%, p = 0.03) and have the metabolic syndrome (87.5% vs. 59.3%, p = 0.02) and/or hypertension (75.0% vs. 50.2%, p = 0.05). In multivariable analyses adjusted for demographics, metabolic syndrome and hypertension remained predictive of NAFLD awareness.


There is low awareness of NAFLD among individuals with hepatic steatosis on imaging, even among those with metabolic risk factors. These findings highlight an opportunity to raise public and practitioner awareness of NAFLD with the goal of increasing diagnosis and implementing early treatment strategies.


NAFLD computed tomography NASH metabolic syndrome hepatic steatosis 



The authors thank the participants of the CARDIA Study for their long-term commitment and important contributions to the study.

Funding Information

The CARDIA Study is supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (HHSN268201800005I & HHSN268201800007I), Northwestern University (HHSN268201800003I), University of Minnesota (HHSN268201800006I), and Kaiser Foundation Research Institute (HHSN268201800004I). Dr. VanWagner is supported by the National Institutes of Health (KL2TR001424) and the NHLBI (K23HL136891). Dr. Carr is supported by the National Institutes of Health (R01HL098445).

Compliance with Ethical Standards

Informed consent was obtained at each follow-up examination. Institutional Review Board (IRB) approval was obtained from all study sites prior to data collection.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5340_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 15 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Erin R. Cleveland
    • 1
  • Hongyan Ning
    • 2
  • Miriam B. Vos
    • 3
  • Cora E. Lewis
    • 4
  • Mary E. Rinella
    • 1
  • John Jeffrey Carr
    • 5
  • Donald M. Lloyd-Jones
    • 2
    • 6
  • Lisa B. VanWagner
    • 1
    • 2
    Email author
  1. 1.Department of Medicine—Division of Gastroenterology & Hepatology Northwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Department of Pediatrics—Division of Gastroenterology, Hepatology & NutritionEmory UniversityAtlantaUSA
  4. 4.Department of Medicine—Division of Preventive MedicineUniversity of Alabama BirminghamBirminghamUSA
  5. 5.Department of RadiologyVanderbilt UniversityNashvilleUSA
  6. 6.Department of Medicine—Division of CardiologyNorthwestern University Feinberg School of MedicineChicagoUSA

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