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RESEARCH ARTICLE
Reported Behaviors of Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: A Key to Improving Communication
Andreas Geier1 ,
Jörn M. Schattenberg2 ,
Andreas Teufel3,4 ,
Rainer Günther5 ,
Alisan Kahraman6 ,
Ali Canbay7 ,
Wolf Peter Hofmann8 ,
Imad Maatouk9 ,
Heide Möller-Slawinski10 ,
Paula Niessing11 ,
Achim Kautz11 ,
Diane Langenbacher11*
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1
Department of Internal Medicine II, University Hospital Würzburg, Würzburg 97080, Bayern,
Germany
2
Department of Internal Medicine II, University Hospital Saarland, Homburg/Saar 66421, Saarland,
Germany
3
Division of Hepatology, Division of Clinical Bioinformatics, Department of Internal Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Baden-Württemberg,
Germany
4
Clinical Cooperation Unit Healthy Metabolism at CPD, Centre for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Baden Württemberg,
Germany
5
Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel 24105, Schleswig-Holstein,
Germany
6
Department of Internal Medicine, Max Grundig Klinik, Bühl 77815, Baden-Württemberg,
Germany
7
Department of Internal Medicine, University Hospital, Knappschaftskrankenhaus, Ruhr University Bochum, Bochum 44892, Nordrhein-Westfalen,
Germany
8
MVZ Gastroenterology Bayerischer Platz Gastroenterology Medical Care Center, Berlin 10825,
Germany
9
Division of Psychosomatic Medicine, Department of Internal Medicine II, University Hospital Würzburg, Würzburg 97080, Bayern,
Germany
10
SINUS Markt- und Sozialforschung GmbH, Heidelberg 69115,
Germany
11
Kautz5 gUG, Köln 51143,
Germany
HPR, e81240034 https://doi.org/10.14440/hpr.0277
Submitted: 26 August 2025 | Revised: 30 September 2025 | Accepted: 27 October 2025 | Published: 6 March 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Abstract
Background
Metabolically dysfunction-associated steatotic liver disease (MASLD) is an increasing public health issue globally.
Objective
This study is the first to explore the detailed behavioral characteristics of patients with MASLD by categorizing them into groups of like-minded individuals, based on similar lifestyle preferences, values, social standing, communication patterns, and consumption behaviors.
Methods
A total of 2,420 anonymized questionnaires were distributed to diagnosed MASLD patients, with 527 responses collected, yielding a 22% response rate. The validated Sinus Institute methodology was extended with a set of investigator-generated questions assessing disease knowledge, comorbidities, and clinically relevant lifestyle patterns within the cohort.
Results
The cohort aligns well with existing clinical data. Compared with the general population, MASLD is overrepresented in the consumer-hedonistic (11% vs. 8%), post-materialist (16% vs. 12%), and conservative-upscale milieu (15% vs. 11%). Notable findings were observed in subpopulations: obesity was the highest in the precarious milieu (23%), type 2 diabetes in the consumer-hedonistic milieu (50%), and hypertension in the traditional milieu (75%).
Conclusion
Metabolic dysfunction-associated steatotic liver disease occurs across all milieus and social classes; however, certain milieus appear particularly relevant and may warrant targeted communication strategies to support sustainable lifestyle changes. Further studies are needed to validate this approach in clinical settings and to determine whether improved, tailored communication enhances adherence to lifestyle interventions and improves clinical outcomes.
Keywords
Type 2 diabetes mellitus
Public health
Lifestyle
Communication
Obesity
Social class
Liver diseases
Surveys and questionnaires
Funding
This work was supported by the unrestricted grants from Gilead Sciences GmbH, NovoNordisk Pharma GmbH, and Pfizer Pharma GmbH.
Conflict of interest
All authors declare no conflicts of interest.
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