Researchers in China surveyed 357 people with non-alcoholic fatty liver disease (a condition where fat builds up in the liver) to see what they knew about eating healthy, what they believed about it, and what they actually did. The study found that most people had poor knowledge about the right foods to eat, but they had positive attitudes about trying to improve. However, very few people were actually following healthy eating habits. The researchers discovered that knowing more about diet didn’t automatically lead to eating better, suggesting that people need better education and support to make real changes.
The Quick Take
- What they studied: Do people with fatty liver disease know what to eat, believe diet matters, and actually follow healthy eating habits?
- Who participated: 357 adults in Sichuan, China who had been diagnosed with non-alcoholic fatty liver disease (fat buildup in the liver not caused by alcohol)
- Key finding: People scored poorly on knowledge about diet (56% of possible points), had good attitudes about trying to eat better (85% of possible points), but only followed healthy eating habits 41% of the time—showing a big gap between what people believe and what they actually do
- What it means for you: If you have fatty liver disease, knowing the right foods isn’t enough—you need practical support and reminders to actually change your eating habits. Simply reading about healthy eating won’t automatically lead to better choices.
The Research Details
Researchers created a survey asking people with fatty liver disease about their knowledge of healthy eating, their beliefs about whether diet matters, and their actual eating habits. They gave the survey to 357 people in Southwest China between July and November 2023. The survey was designed to measure three things: knowledge (understanding what foods are healthy), attitude (believing diet is important), and practice (actually eating those foods). The researchers tested the survey to make sure it was reliable and consistent in measuring these three areas.
This type of study helps doctors and health educators understand why people don’t always follow healthy eating advice. By measuring knowledge, beliefs, and actual behavior separately, researchers can figure out where the biggest problems are. In this case, it shows that the problem isn’t just that people don’t know what to eat—it’s that even when they believe diet is important, they still don’t do it.
The survey was well-designed with good internal consistency (Cronbach’s α = 0.896, which means the questions reliably measured what they were supposed to measure). However, this was a snapshot study taken at one point in time in one region of China, so the results may not apply to all people with fatty liver disease everywhere. The researchers used convenience sampling, meaning they didn’t randomly select participants, which could introduce some bias.
What the Results Show
The study revealed three important patterns. First, people’s knowledge about diet for fatty liver disease was poor—they scored an average of 19.75 out of 35 possible points (56%). Second, their attitudes were positive—they scored 51.21 out of 60 possible points (85%), showing they believed diet was important. Third, their actual eating practices were poor—they only followed healthy eating habits 41% of the time, scoring 6.58 out of 16 possible points.
Interestingly, the relationships between these three areas were weak and sometimes unexpected. People with more knowledge had slightly better attitudes about diet, but surprisingly, people with better attitudes actually had worse eating practices. This suggests that simply believing diet is important doesn’t automatically lead to eating better.
The path analysis (a statistical method that shows how different factors influence each other) revealed that knowledge influenced attitude positively—learning more about diet made people believe it was more important. However, attitude actually had a small negative influence on practice, meaning that people who believed diet was very important sometimes did worse at actually eating healthy. This counterintuitive finding suggests that high expectations or anxiety about diet might actually make it harder for people to follow through.
This study adds to growing evidence that the gap between knowing what’s healthy and actually doing it is a major problem in managing chronic diseases. Previous research on other conditions has shown similar patterns—people often know what they should do but struggle to do it. This study specifically shows that for fatty liver disease, the problem is not just education but also helping people translate their beliefs into actual behavior change.
The study only included people from one region in China, so results may not apply to people in other countries or cultures with different food systems and healthcare access. The researchers used convenience sampling rather than random selection, which could mean the people surveyed weren’t fully representative of all people with fatty liver disease. The study was done at one point in time, so it can’t show how knowledge, attitudes, and practices change over time. Finally, the study relied on people’s self-reported answers about their eating habits, which may not be completely accurate.
The Bottom Line
If you have fatty liver disease: (1) Work with a doctor or dietitian to create a specific eating plan, not just general advice about healthy eating. (2) Focus on practical strategies like meal planning, grocery shopping lists, and cooking tips rather than just learning about nutrition. (3) Find support through family, friends, or support groups to help you stick with changes. (4) Start with small, manageable changes rather than trying to overhaul your entire diet at once. These recommendations are based on moderate evidence that education alone isn’t enough—you need practical support and accountability.
This research is important for people diagnosed with non-alcoholic fatty liver disease who want to improve their health through diet. It’s also valuable for doctors, nurses, and dietitians who work with these patients, as it shows they need to focus on practical behavior change strategies, not just education. People at risk for fatty liver disease (those who are overweight, have diabetes, or have metabolic syndrome) should also pay attention, as diet can help prevent the disease from developing.
Changing eating habits typically takes 4-12 weeks to become more automatic, though you may notice improvements in how you feel (more energy, less bloating) within 2-4 weeks. Improvements in liver health usually take 3-6 months to show up on blood tests or imaging, and longer-term benefits develop over 6-12 months of consistent healthy eating.
Want to Apply This Research?
- Track daily meals and snacks for one week, noting which foods align with your fatty liver diet plan (like vegetables, whole grains, lean proteins) versus foods to limit (like fried foods, sugary drinks, processed foods). Calculate the percentage of meals that followed your plan each day.
- Use the app to set one specific, achievable eating goal each week (for example: ‘Eat vegetables with dinner 5 days this week’ or ‘Replace sugary drinks with water 4 days this week’). Get daily reminders and check off when you complete the goal.
- Review your weekly eating pattern reports in the app to identify your biggest challenges (certain times of day, specific foods, social situations). Adjust your goals based on what’s working and what’s not, gradually building better habits over 8-12 weeks.
This research describes what people with fatty liver disease know and do about eating, but it doesn’t provide medical advice. If you have been diagnosed with non-alcoholic fatty liver disease, consult with your doctor or a registered dietitian before making significant changes to your diet. This study was conducted in China and may not fully apply to other populations. Individual results vary based on genetics, overall health, and other factors. Always work with your healthcare team to develop a personalized eating plan appropriate for your specific condition.