Quality of life in adults with nonalcoholic fatty liver disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the UnitedStates. The association between NAFLD and quality of life (QOL) remains unclear. These data are important to estimate the burden of illness in NAFLD. The aim was to report QOL scores of adults with NAFLD and examine the association between NAFLD severity and QOL. QOL data were collected from adults with NAFLD enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network using the Short Form 36 (SF-36) survey, and scores were compared with normative U.S. population scores. Liver biopsy histology was reviewed by a central pathology committee. A total of 713 subjects with NAFLD (male ‫؍‬ 269, female ‫؍‬ 444) were included. Mean age of subjects was 48.3 years; 61% had definite nonalcoholic steatohepatitis (NASH), and 28% had bridging fibrosis or cirrhosis. Diabetes was present in 27% of subjects. Subjects with NAFLD had worse physical (mean, 45.2) and mental health scores (mean, 47.6) compared with the U.S. population with (mean, 50) and without (physical, 55.8; mental, 52.5) chronic illness. Subjects with NASH reported lower physical health compared with subjects with fatty liver disease without NASH (44.5 versus 47.1, P ‫؍‬ 0.02). Subjects with cirrhosis had significantly (P < 0.001) poorer physical health scores (38.4) than subjects with no (47.6), mild (46.2), moderate (44.6), or bridging fibrosis (44.6). Cirrhosis was associated with poorer physical health after adjusting for potential confounders. Mental health scores did not differ between participants with and without NASH or by degree of fibrosis. Conclusion: Adults with NAFLD have a significant decrement in QOL. Treatment of NAFLD should incorporate strategies to improve QOL, especially physical health. (HEPATOLOGY 2009;49:1904-1912

Silybin combined with phosphatidylcholine and vitamin E in patients with nonalcoholic fatty liver disease: A randomized controlled trial

“…AST, ALT, and γGT plasma levels were determined at baseline and every 3 months. The following assessments were completed at baseline, 6 months (T 6 ), and 12 months (T 12 ): body mass index (BMI; overweight, BMI ≥25 and b30 kg/m 2 ; obese, BMI ≥30 kg/m 2 ); abdominal circumference and waist-to-hip ratio; abdominal ultrasonography (severity graded on semiquantitative scale: 0, absent; 1, mild; 2, moderate; and 3, severe) [22]; quality of life (QoL; 36-item short-form health survey (SF-36)) [23]; routine biochemistry tests (blood urea nitrogen, creatinine, bilirubin, total protein, alkaline phosphatase, uric acid, blood cell count, and prothrombin activity); HCV RNA levels (HCV-positive patients); plasma levels of glucose, triglycerides, cholesterol, ferritin, and insulin; and homeostatic model assessment (HOMA) [24]. Cytokines (tumor necrosis factor α (TNF-α), interleukin 10 (IL-10), transforming growth factor β (TGF-β)) and liver fibrosis markers (hyaluronic acid, matrix metalloproteinase 2 (MMP-2), procollagens I and III, tissue inhibitor of metalloproteinases 1 and 2 (TIMP-1 and -2)) were assessed at baseline and at T 12 [25,26].…”

Insulin sensitisers in the treatment of non-alcoholic fatty liver disease: a systematic review.

“…David et al 145 from the NASH Clinical Research Network (CRN) Research Group administered the SF-36 to 713 people enrolled in two studies, one an observational cohort, the other the PIVENS (Pioglitazone Versus Vitamin E Versus Placebo for the Treatment of Non-diabetic Patients with Non-alcoholic Steatohepatitis) trial. Most (61%) had NASH, and 28% had fibrosis or cirrhosis.…”

“…The results in the NAFLD group were compared with the general US population and adjusted for age. Because the general population also have chronic diseases (including, at the relevant age, 22% with diabetes and 27% with hypertension), David et al 145 compared the NAFLD group with the whole general population and after excluding those in the general population with chronic diseases. In the NAFLD/NASH group, 72% were obese.…”

Impact of Betaine on Hepatic Fibrosis and Homocysteine in Nonalcoholic Steatohepatitis - A Prospective, Cohort Study

“…Betaine intolerance was also an important issue in 20% of patients whose symptoms resolved rapidly after treatment discontinuation. However, aside from mild gastrointestinal side effects, no serious adverse effects were observed with betaine which has been viewed as a safe supplement for a variety of diseases and also associated with a positive impact on quality of life in patients with NASH [26].…”