Knowledge, attitudes, and practices toward fatty liver disease in patients with hepatitis B combined fatty liver disease

To assess the knowledge, attitudes, and practices (KAP) of patients with chronic hepatitis B (CHB) combined with metabolic-associated fatty liver disease (MAFLD) toward fatty liver disease. This cross-sectional study was conducted between October and November 2024 across multiple centers in the Chongqing region. Data collection and KAP score assessment were performed through questionnaire. The analysis included 477 valid questionnaires. The average knowledge, attitude, and practice scores were 8.24 ± 5.05 (possible range: 0–18, 45.78%), 34.87 ± 2.93 (possible range: 9–45, 77.49%), and 32.02 ± 4.67 (possible range: 8–40, 80.05%), indicating poor knowledge, moderately positive attitudes, and relatively proactive practices. Multivariate logistic regression analysis showed that knowledge score (OR = 1.10, 95% CI: 1.05–1.16), attitude score (OR = 1.27, 95% CI:1.16–1.39), body mass index (OR = 0.91,95% CI: 0.84–0.99), obesity/overweight (OR = 2.82, 95% CI: 1.60–4.97), diabetes (OR = 4.55, 95% CI: 2.14–9.70), hypertension (OR = 0.41, 95% CI: 0.21–0.81), hyperlipidemia (OR = 0.35, 95% CI: 0.17–0.73), hyperuricemia (OR = 3.00, 95% CI: 1.44–6.25), coronary heart disease (OR = 27.60, 95% CI:4.92–155), exercising (OR = 0.21–0.43, 95% CI:0.10–0.70) were independently associated with the practice scores. In the structural equation model, knowledge influenced attitude (β = 0.23, P < 0.001) and practices (β = 0.23, P < 0.001), and attitudes influenced practices (β = 0.41, P < 0.001). Patients with CHB and MAFLD display poor knowledge, positive attitudes, and proactive practices toward fatty liver. Although patients already demonstrated relatively proactive practices, further improvements could be achieved through education aimed at enhancing knowledge and attitudes. In clinical practice, healthcare providers should integrate structured patient education, such as individualized counseling during outpatient visits, educational materials on CHB–MAFLD interactions, and multidisciplinary lifestyle support including diet, exercise, and psychological guidance, into routine management. These targeted interventions could help close key knowledge gaps, strengthen attitudes, and reinforce sustainable health behaviors in this high-risk population. Registry: Chinese Clinical Trial Registry, TRN: ChiCTR2400095024, Registration date: 31 December 2024.