Lower Health Literacy Is Associated With Greater Severity of Metabolic Dysfunction and Steatotic Liver Disease

The spectrum of health literacy in metabolic dysfunction-associated steatotic liver disease (MASLD) patients and its relationship to disease severity are largely unknown. We performed an exploratory cross-sectional study regarding health literacy in this population.

The Health Literacy Questionnaire (HLQ) was administered to 101 individuals with MASLD attending an ambulatory hepatology clinic; data were obtained from medical records. Scores per HLQ scale were related to disease severity by Spearman coefficient, t-test, and multivariate regression. Clustering analyses were performed. Significance was set at P < .05.

In HLQ part 1 (scored 1-4), the highest scoring scale was feeling understood and supported by health-care providers (mean ± standard deviation) (3.43 ± 0.6). In HLQ part 2 (scored 1-5), the highest scoring scale was understanding health information well enough to know what to do (4.12 ± 0.57). In HLQ part 1, the lowest scoring scale was actively managing health (2.98 ± 0.6). In HLQ part 2, the lowest scoring scale was navigating the health system (3.83 ± 0.71). A decreased ability to actively manage health was associated with higher liver steatosis (r = -0.29, P = .01) and body mass index (r = -0.38, P = <.001). A decreased ability to understand health information (r = -0.24, P = .04) was associated with higher liver stiffness. Higher education was positively correlated with finding (r = 0.25, P = .01), appraising (r = 0.24, P = .01), and understanding (r = 0.34, P = <.001) health information. Two main clusters of health literacy patterns were observed; one with higher education, higher health literacy, and less severe MASLD.

Lower education and health literacy are associated with more advanced MASLD and metabolic dysfunction.