Here’s a concise summary of the article “Low awareness of Metabolic dysfunction–associated steatotic liver disease (MASLD) among U.S. adults: Trends from National Health and Nutrition Examination Survey (NHANES) 2017–2023” by Alp et al., Hepatology Communications (November 2025).
Key findings
- The survey included ~13,190 U.S. adults (representing ~219 million individuals after weighting) from NHANES cycles 2017–2020 (pre-pandemic) and 2021–2023 (late-pandemic).
- Prevalence of hepatic steatosis was about 42.2% pre-pandemic and 39.7% in the late-pandemic period (not statistically significant, p=0.08).
- Among those with steatosis, about 91.4% pre-pandemic and 90.5% late-pandemic met the MASLD definition (≈50.5 million and 30.4 million U.S. adults, respectively).
- Awareness of having a liver disease among individuals with MASLD was extremely low: 5.8% (95% CI: 4.5–7.2%) pre-pandemic and 6.7% (95% CI: 5.4–8.1%) late-pandemic (p = 0.36).
- Among those with more advanced disease (compensated advanced chronic liver disease – cACLD), awareness rose somewhat from 8.5% (95% CI: 2.8–14.2%) to 20.4% (95% CI: 13.8–27.0%) (p = 0.02).
- Among those eligible for the drug Resmetirom (for MASLD with F2–F3 fibrosis), awareness remained low: ~12.1% pre-pandemic vs ~10.3% late-pandemic (p = 0.63).
- Certain clinical factors were independently associated with greater awareness: central obesity (OR ~3.4), hypertension (OR ~1.7), and diabetes (OR ~1.7).
Implications
- Despite the high prevalence of MASLD in U.S. adults, awareness is abysmally low, meaning most people with the disease do not know they have it.
- The gap persists even though we now have emerging therapies (e.g., Resmetirom) and major advances in liver disease management. Awareness is a bottleneck to diagnosis → intervention.
- The modest increase in awareness in more advanced disease is encouraging, but still very low, and many with milder disease remain undiagnosed/unaware.
- The pandemic context (sedentary behavior, metabolic worsening) may have influenced disease burden, yet awareness did not improve meaningfully.
- For stakeholders like your organization, this signals a large unmet need in screening/education — especially for early-stage MASLD before progression to fibrosis or cirrhosis.
LiverRight’s 5-Point Plan to Address Low Awareness of Liver Disease in the USA
- Make access 10x better than the current state — patients get in same-week versus months out.
- Make the appointments virtual and thus far more convenient than in-person. This bears on what we call “Appointment Adherence.”
- Deftly utilize blood-based testing and scanning, including both TE/SWE (ultrasound) and Liver CT/MRI, including with AI over the top of the Liver MRI as clinically merited.
- Utilize a home test as a screener to insert a key rung in the diagnostic ladder between the patient doing NOTHING and moving to a visit with a Hep or Hep APP, either in-person or (as LiverRight makes every appointment) via telemedicine.
- Encourage patients to raise their hands for a triage appointment, or the home test to start. But it won’t be enoughgiven some ~100 million undiagnosed American adults with Liver Disease.
Which is why we have an EMR Query for our provider partners. It’s called Find42™. An homage to this research spotlighting 42% from November of 2024: “More than 40% of U.S. adults have liver disease, with higher risk among Hispanics, new study finds“.