Abstract

Background and Objectives: Lifestyle modification is the cornerstone of liver disease management; however, its success depends on accurate self-assessment. We investigated the clinical characteristics of individuals at risk of liver fibrosis and the discrepancy between their objective risk and self-perceived lifestyle habits in patients with steatotic liver disease. Methods and Study Design: This cross-sectional study included 167 participants diagnosed with steatotic liver disease. Participants were categorized into a high-risk group (n = 57) and a control group (n = 110) based on the age-adjusted Fibrosis-4 index cutoffs. Multivariable logistic regression was used to identify independent factors, and self-perceived habits were compared to evaluate cognitive–clinical discrepancies. Results: Age was identified as the sole independent clinical factor associated with the risk of fibrosis. The high-risk group exhibited significantly lower alanine aminotransferase and triglyceride levels than those of the control group. Despite their higher clinical risk, the high-risk group reported significantly higher engagement in habitual exercise (53% vs. 31%, p = 0.006) and restorative sleep (odds ratio: 3.24). High-risk individuals were also significantly less likely to report the frequent intake of sweets (odds ratio: 0.253). Conclusions: A profound cognitive–clinical discrepancy exists among individuals at risk for liver fibrosis, which may lead them to misinterpret pathologically declining biomarkers as successful outcomes of their lifestyle efforts. Health promotion must move beyond general advice to incorporate perception-correcting feedback that reconciles subjective health views with objective pathological realities.

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