In a cross-sectional survey of 460 Italian adults with physician-diagnosed MASLD, 59.8% had never heard of the condition before diagnosis, and only 8.5% recognised the current name. Some 43.5% did not identify diabetes as a risk factor, and 51.5% believed progression requires elevated ALT. Despite physician counselling, 75.7% fell short of 150 minutes of weekly activity and 26.1% were fully inactive. Supplements were used by 27.6%, mostly self-prescribed, while half of those on drugs received ursodeoxycholic acid, which guidelines do not endorse.
The central insight is the attitude-practice gap: patients were counselled and still did not move, which suggests advice alone fails and that behavioural support, not more information, is the missing ingredient. Exercise and weight loss remain the best-evidenced MASLD therapies, with 7-10% weight loss linked to histological improvement. The widespread belief that normal transaminases mean a healthy liver is dangerous, since advanced fibrosis can exist with normal ALT, so people with diabetes or obesity should ask about fibrosis screening such as FIB-4 or elastography regardless of blood results. The finding that depression and female sex drove symptom burden deserves follow-up. Limitations are real: self-reported diagnosis, a patient-association sample likely skewed toward engaged patients, no causal inference, and Italy-only data. The work is confirmatory rather than paradigm-shifting, but it usefully quantifies where clinical communication is failing.