{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:06:46Z","timestamp":1787069206313,"version":"build-2736575974"},"reference-count":55,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gilead Science Inc.","award":["IN-EU989-5753"],"award-info":[{"award-number":["IN-EU989-5753"]}]},{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"crossref","award":["1S73421N"],"award-info":[{"award-number":["1S73421N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Objectives: The objective of this study was to investigate metabolic dysfunction-associated steatotic liver disease (MASLD)-related awareness, health literacy (HL), and illness perception among patients at risk of MASLD in European primary care settings. Methods: Participants aged \u226550 years with either obesity, metabolic syndrome (MetS), or type 2 diabetes mellitus (T2DM), and attending general practices (GPs) in Greece, Spain, or The Netherlands were included in the study. The participants completed surveys to collect data on their socio-demographic characteristics and health habits, including the European Health Literacy Survey (HLS-E-Q16), the Brief Illness Perception Questionnaire [B-IPQ], and the Public Awareness of NAFLD Questionnaire. Results: Overall, 234 patients participated in the study (mean age: 66.5 \u00b1 9.5 years; 45.7% were male). Among the participants, 64.5%, 66.2%, and 59.8% had a diagnosis of diabetes, obesity, and MetS, respectively. Almost one-third (27.9%) had never heard about MASLD or discussed MASLD with their GP. Twelve percent (12.1%) had never heard about cirrhosis, and 20.5% were unaware that liver disorders may cause serious health problems. Overall, 43.6% of the patients had a sufficient level of HL (score &gt;13) with a mean score of 11.5 \u00b1 3.3. Illness perception (B-IPQ score) was low at 41.6 \u00b1 11.6. Significantly higher B-IPQ scores were documented for female compared to male respondents (43.1 vs. 39.8; p &lt; 0.01). Multivariate analysis found that knowledge about MASLD was associated with higher HLS-E-Q16 (p = 0.017) and B-IPQ (p = 0.028) scores. Conclusions: Despite being at risk, a significant proportion of the study participants were unaware of MASLD, its risk factors, and their personal susceptibility. This study underscores the importance of enhancing patient HL and promoting prevention and risk reduction, particularly among high-risk patient populations.<\/jats:p>","DOI":"10.3390\/diseases14040147","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T14:24:51Z","timestamp":1776435891000},"page":"147","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Towards a Better Understanding of MASLD: Patient Health Literacy, Illness Perception, and Awareness"],"prefix":"10.3390","volume":"14","author":[{"given":"Irini","family":"Gergianaki","sequence":"first","affiliation":[{"name":"Clinic of Social and Family Medicine, School of Medicine, University of Crete, 70013 Heraklion, Crete, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Foteini","family":"Anastasiou","sequence":"additional","affiliation":[{"name":"4th Local Primary Health Care Team, 71303 Heraklion, Crete, Greece"},{"name":"European Society for Primary Care Gastroenterology, London E1 6HU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Papadakis","sequence":"additional","affiliation":[{"name":"Clinic of Social and Family Medicine, School of Medicine, University of Crete, 70013 Heraklion, Crete, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2306-1626","authenticated-orcid":false,"given":"Marilena","family":"Anastasaki","sequence":"additional","affiliation":[{"name":"Clinic of Social and Family Medicine, School of Medicine, University of Crete, 70013 Heraklion, Crete, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3849-3907","authenticated-orcid":false,"given":"Manolis","family":"Linardakis","sequence":"additional","affiliation":[{"name":"Clinic of Social and Family Medicine, School of Medicine, University of Crete, 70013 Heraklion, Crete, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8095-7707","authenticated-orcid":false,"given":"Juan","family":"Mendive","sequence":"additional","affiliation":[{"name":"European Society for Primary Care Gastroenterology, London E1 6HU, UK"},{"name":"La Mina Primary Health Care Academic Centre, University of Barcelona, 08007 Barcelona, Spain"},{"name":"IDIAP Jordi Gol Research Institute, 08007 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4850-6011","authenticated-orcid":false,"given":"Leen J. M.","family":"Heyens","sequence":"additional","affiliation":[{"name":"Faculty of Health and Life Sciences, Hasselt University, 3500 Hasselt, Belgium"},{"name":"School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6211 LK Maastricht, The Netherlands"},{"name":"LCRC (-MHU), Department Future Health and Gastro-enterology and Hepatology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ger","family":"Koek","sequence":"additional","affiliation":[{"name":"School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6211 LK Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8780-476X","authenticated-orcid":false,"given":"Jean","family":"Muris","sequence":"additional","affiliation":[{"name":"European Society for Primary Care Gastroenterology, London E1 6HU, UK"},{"name":"Department of Family Medicine, CAPHRI Research Institute, Maastricht University, 6229 HA Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9324-2839","authenticated-orcid":false,"given":"Christos","family":"Lionis","sequence":"additional","affiliation":[{"name":"Clinic of Social and Family Medicine, School of Medicine, University of Crete, 70013 Heraklion, Crete, Greece"},{"name":"European Society for Primary Care Gastroenterology, London E1 6HU, UK"},{"name":"Department of Psychology, School of Social Sciences and Humanities, University of Limassol, Limassol 3025, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0140-6736(21)01701-3","article-title":"The EASL-lancet liver commission: Protecting the next generation of Europeans against liver disease complications and premature mortality","volume":"399","author":"Karlsen","year":"2022","journal-title":"Lancet"},{"key":"ref_2","unstructured":"European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), and European Association for the Study of Obesity (EASO) (2024). 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