A qualitative study of self‐management experiences in people with non‐alcoholic fatty liver disease

Abstract

Non-alcoholic fatty liver disease (NAFLD), which is characterized by excessive fat accumulation in the liver in people without excessive alcohol use, affects approximately one fourth of the global and South Korean populations (Araujo et al., 2018;Bellentani, 2017;Kwak & Kim, 2018). Once NAFLD has progressed, it is irreversible and can lead to liver fibrosis, cirrhosis or hepatocellular carcinoma (European Association for the Study of the Liver, 2016). The progression of NAFLD not only imposes a clinical burden on patients but also affects their survival rate and quality of life (Perumpail et al., 2017;Younossi & Henry, 2015). A recent study reported NAFLD-related cirrhosis and hepatocellular carcinoma as the second leading cause of liver transplantation in the United States (Bellentani, 2017).Further, studies have demonstrated that people with NAFLD have a higher mortality rate than the general population (Bellentani, 2017;European Association for the Study of the Liver, 2016).Unlike alcoholic fatty liver disease, for which the main risk factor is excessive alcohol consumption, risk factors for NAFLD include obesity, dyslipidaemia and type 2 diabetes. However, in the absence of a pharmacological therapy, NAFLD treatment is focused on metabolic profile improvement (Araujo et al., 2018;Bellentani, 2017).Clinical guidelines for managing NAFLD emphasize lifestyle modification, which includes a low-calorie diet; lower intake of refined carbohydrates, fat and sugar; and increased physical activity (European Association for the Study of the Liver, 2016;Katsagoni et al., 2017). This suggests that patients with NAFLD require lifetime disease monitoring and management.

Living in the non‐alcoholic fatty liver disease silent epidemic: a qualitative systematic review of patients' perspectives

“…A recurring concern was the general change in mood with reports of depression and anxiety from NAFLD 30,32,35 . Patients were also stressed and overwhelmed regarding the management of NAFLD in the absence of clear directions and quantifiable actions 35 . While they relied on friends, family or online media for advice, many non‐professionals lacked knowledge on the appropriate dietary advice suitable for NAFLD and the conflicting information resulted in feelings of frustration or confusion 32,35 …”

“…Patients voiced their self‐motivation to improve dietary habits and physical activity after a diagnosis of NAFLD with many citing supportive family as a major proponent for change 29,35,36 . A diagnosis of NAFLD resulted in some participants reducing their intake of unhealthy foods and cutting down on fat, sugar, salt, carbohydrate and red meat consumption 29,35 . Patients also reported increase in physical activity both intentionally and opportunistically 29,36 …”

“…35 While they relied on friends, family or online media for advice, many non-professionals lacked knowledge on the appropriate dietary advice suitable for NAFLD and the conflicting information resulted in feelings of frustration or confusion. 32,35…”

“…29,35,36 A diagnosis of NAFLD resulted in some participants reducing their intake of unhealthy foods and cutting down on fat, sugar, salt, carbohydrate and red meat consumption. 29,35 Patients also reported increase in physical activity both intentionally and opportunistically. 29,36…”

Barriers and enabling factors in weight management of patients with nonalcoholic fatty liver disease: A qualitative study using the COM‐B model of behaviour

“… 8 Unfortunately, although the significance of weight management for patients with NAFLD has been recognized by experts and doctors, the management of patients' weights is still not adequately implemented. 9 , 10 , 11 , 12 Possible explanations include the lack of implementation of behavioural programmes, lack of funds, clinicians' hesitancy to offer support and other factors. Guidance from theory might contribute to addressing these issues.…”