Association between Non-Alcoholic Fatty Liver Disease and Dietary Habits, Stress, and Health-Related Quality of Life in Korean Adults

Abstract

Considering the increasing prevalence of non-alcoholic fatty liver disease (NAFLD), this study aimed to evaluate the association between NAFLD and dietary habits, stress, and health-related quality of life (HRQoL) in Korean individuals by using data from the Korea National Health and Nutrition Examination Survey (KNHANES) VI 2013–2015. NAFLD was defined in individuals with a hepatic steatosis index (HSI) value ≥36. Eating habits were assessed based on the frequencies of eating and eating out; stress was assessed through the stress perception rate; and the EuroQol-5D (EQ-5D) questionnaire was used to assess the HRQoL. We performed a complex sample logistic regression analysis and estimated the odds ratios by adjusting for significant factors to evaluate associations between NAFLD and dietary habits, stress, and HRQoL. Occurrence of NAFLD was not significantly associated with meal frequencies over one week. With an increase in stress, based on the stress perception rate, the risk of NAFLD increased 1.316-fold (95% confidence interval (CI): 1.175–1.469, p < 0.05). Additionally, a decrease in the EQ-5D score by 1 increased the risk of NAFLD 3.38-fold (95% CI: 1.893–4.844, p < 0.05). Thus, NAFLD treatment should include stress management, and underlying HRQoL should be considered during treatment.

Retinoic Acid: A New Old Friend of IL-17A in the Immune Pathogeny of Liver Fibrosis

“…The background of liver fibrosis involves multiple processes, including alcoholic lesions, chronic forms of viral hepatitis, and metabolic syndrome, which is becoming one of the most important causes today, a burden on our society. Western diets, reduced physical activity, and constant stress all actively contribute to the dramatic increase in nonalcoholic steato-hepatitis (NASH) prevalence ( 3 , 4 ).…”

Non-Alcoholic Fatty Liver Disease (NAFLD) and Potential Links to Depression, Anxiety, and Chronic Stress

“…In this study, HRQoL was assessed by the EuroQol-5D (EQ-5D) instrument, which measures/comprises of five dimensions, namely, mobility, self-care, usual activities, pain/ discomfort, and anxiety/depression. This study showed that a decrease in the EQ-5D score by one unit was associated with increased risk of NAFLD by more than threefold, raising the awareness of considering HRQoL in the context of NAFLD [58].…”

“…Notably, in exploring correlations between NAFLD, dietary habits, stress, and HRQoL in Korean individuals, Han [58] identified a 1.3-fold increase in the risk of NAFLD in individuals with increased perceived stress, suggesting that stress management should be included in the treatment of NAFLD [58]. Furthermore, a large cross-sectional study involving 171,321 apparently healthy Korean adults identified an independent association between higher levels of perceived stress and a higher prevalence of NAFLD [56].…”

“…Another recent study, which explored the relationship between NAFLD and dietary habits, stress, and HRQoL, reported reduced HRQoL in Korean adults with NAFLD [58]. In this study, HRQoL was assessed by the EuroQol-5D (EQ-5D) instrument, which measures/comprises of five dimensions, namely, mobility, self-care, usual activities, pain/ discomfort, and anxiety/depression.…”

“…As aforementioned, insulin resistance is also included among the detrimental effects of HPA dysfunction, mediated mostly via over-secretion of cortisol by the adrenals and of adipokines/cytokines by the accumulated excess and/or ectopic adipose tissue [10,13,23]. Overall, there appears to be an interaction between insulin resistance, psychological health, and NAFLD [58]. Interestingly, in testing the hypothesis that insulin resistance or inflammation might partially explain the relationship between depression and NAFLD, Lee et al [84] were unable to identify such a link when utilizing CRP as a biomarker.…”