Introduction Non-alcoholic fatty liver disease (NAFLD) affects 25% of the population and is a frequent manifestation of the metabolic syndrome (MetS), therefore patients may be seen by healthcare professionals (HCP) in a variety of non-specialist secondary care teams. Awareness of the significance of NAFLD as a MetS co-factor, ability to offer basic lifestyle advice and recognise that specialist referral may be required is critical to optimising MetS care.
Methods A questionnaire study was conducted to examine non-specialist HCP knowledge of NAFLD in our large teaching hospital. Questionnaires were distributed at random to medical (n=20) and nursing staff (n=36) in several wards and clinics. Questions explored understanding of NAFLD risk factors, assessment and management.
Results Respondents were predominantly female (n=40), with median age 35 (range 20–60). Most (51/56; 91.1%) had heard of NAFLD but significantly fewer nurses were aware of non-alcoholic steato-hepatitis (NASH) than medics (47% vs 100%; p<0.001). Most (55/56; 98.2%) recognised that steatosis could cause liver damage, although serious complications were poorly appreciated including risk of liver cancer (32/56; 57.1%) and cirrhosis (45/56; 80.4%), with nurses significantly less aware of cirrhosis risk than medics (72.2% vs 95%; p=0.04). Awareness of MetS features as NAFLD risk factors varied; whilst most identified overweight/obesity (96.4%), significantly fewer recognised type 2 diabetes (T2DM) (76.8%; p<0.001) or hypertension (48.2%; p<0.001). Symptom knowledge was poor with nobody recognising NAFLD may be asymptomatic, and many thinking even early disease would be heralded by jaundice (24/56; 42.9%) or ascites (18/56; 32.1%). The majority understood need for ultrasound (52/56; 92.9%) and liver function tests (43/56; 76.8%) for diagnosis but importance of risk stratification was under-appreciated; just 62.5% would calculate BMI and 57.1% would test for T2DM. Although most (42/56; 75%) said NAFLD was preventable, 7/56 (12.5%) did not know that weight loss could reverse NAFLD, and just 19/56 (33.9%) identified the correct targets to offer appropriate weight loss advice. Knowledge of how to lose weight was also limited, with 12.5% recommending rapid weight loss, and only 32.1% (18/56) aware of the Mediterranean diet.
Conclusions There was a lack of recognition that early NAFLD may be asymptomatic despite causing harm, and limited understanding of the impact of MetS and lifestyle factors on both causation and treatment. Since patients with NAFLD are frequently encountered by non-specialists and are at high risk of morbidity, HCP NAFLD education should be improved to ensure that those presenting to other teams are advised appropriately and referred for liver risk assessment.
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