Low Awareness of Nonalcoholic Fatty Liver Disease in a Population-Based Cohort Sample: the CARDIA Study
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).
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.”
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.
KEY WORDSNAFLD 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.
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.
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