Depression in non-alcoholic fatty liver disease is associated with an increased risk of complications and mortality

Abstract

Background and aimsThe global prevalence of non-alcoholic fatty liver disease (NAFLD) is expected to rise continuously. Furthermore, emerging evidence has also shown the potential for concomitant depression in NAFLD. This study aims to examine the prevalence, risk factors, and adverse events of depression in NAFLD and evaluate whether treated depression can reverse the increased risks of adverse outcomes.Materials and methodsThis study analyses the 2000–2018 cycles of NHANES that examined liver steatosis with fatty liver index (FLI). The relationship between NAFLD and depression was assessed with a generalized linear mix model and a sensitivity analysis was conducted in the no depression, treated depression, and untreated depression groups. Survival analysis was conducted with cox regression and fine gray sub-distribution model.ResultsA total of 21,414 patients were included and 6,726 were diagnosed with NAFLD. The risk of depression in NAFLD was 12% higher compared to non-NAFLD individuals (RR: 1.12, CI: 1.00–1.26, p = 0.04). NAFLD individuals with depression were more likely to be older, females, Hispanics or Caucasians, diabetic, and have higher BMI. Individuals with depression have high risk for cardiovascular diseases (CVD) (RR: 1.40, CI: 1.25–1.58, p < 0.01), stroke (RR: 1.71, CI: 1.27–2.23, p < 0.01), all-cause mortality (HR: 1.50, CI: 1.25–1.81, p < 0.01), and cancer-related mortality (SHR: 1.43, CI: 1.14–1.80, p = 0.002) compared to NAFLD individuals without depression. The risk of CVD, stroke, all-cause mortality, and cancer-related mortality in NAFLD individuals with treated depression and depression with untreated treatment was higher compared to individuals without depression.ConclusionThis study shows that concomitant depression in NAFLD patients can increase the risk of adverse outcomes. Early screening of depression in high-risk individuals should be encouraged to improve the wellbeing of NAFLD patients.

Non-alcoholic fatty liver disease and coexisting depression, anxiety and/or stress in adults: a systematic review and meta-analysis

“…It is important to highlight that there could be many other factors that may contribute to the mental health and well-being of patients with NAFLD, including symptoms of fatigue which may impact on quality of life and the high risk of significant complications, as well as the lack of awareness of the condition and perceived stigmatization ( 28 ). Furthermore, it is reported that NAFLD patients with depression are at a greater risk of adverse outcomes, such as stroke, CVD and cancer-related mortality compared to those without depression ( 90 ). Similarly, anxiety has been shown to be associated with a number of health issues including CVD, hypertension and gastrointestinal issues ( 91 ), and increased levels of anxiety among NAFLD patients might also lead to further physical complications.…”

Non-alcoholic fatty liver disease associated with greater herpes zoster risk than alcoholic fatty liver disease

“…Ng et al reported a risk of depression for individuals with NAFLD was 12% higher than that for those without NAFLD [ 29 ]. In another study, patients with NAFLD had a significantly higher risk of depression (OR = 1.13) than did those without NAFLD, and patients with depression had a significantly higher risk of developing NAFLD (OR = 1.46) than did those without.…”

“…The authors demonstrated that NAFLD and depression are highly correlated and can interact [ 30 ]. Because concurrent depression in NAFLD can amplify the likelihood of negative health consequences, Ng et al suggested that early screening for depression in high-risk individuals with NAFLD can improve their well-being [ 29 ]. Two population-based studies have demonstrated strong associations between depression and HZ, indicating that the HR of depression for HZ development is 1.1 (compared with no depression) [ 31 , 32 ].…”

Association between Weight-Adjusted Waist Index and Depression in NAFLD: The Modulating Roles of Sex and BMI

“…Adiposity and dysregulation of adipose tissue lipid metabolism in NAFLD are thought to be involved in the pathogenesis of depression, suggesting an important role for obesity and adipose tissue function in the liver-brain axis in NAFLD [18, 19. ] Depression and NAFLD co-morbidity were signi cantly associated with an increased prevalence of CVD and risk of mortality compared to individuals with NAFLD not experiencing depression [20]. Therefore, identifying modi able risk factors for depression in NAFLD patients is clinically crucial.…”