Support Needs and Coping Strategies in Non-Alcoholic Fatty Liver Disease (NAFLD): A Multidisciplinary Approach to Potential Unmet Challenges beyond Pharmacological Treatment

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most frequently occurring chronic liver disease, affecting approximately 25–30% of the adult general population worldwide. NAFLD reflects excess hepatic accumulation of fat in the absence of increased alcohol intake, and, due to its close association with obesity, is frequently referred to as the ‘hepatic manifestation’ of metabolic syndrome. Indeed, a high percentage of individuals with NAFLD present with a combination of the cardio-metabolic comorbidities that are associated with the metabolic syndrome. In addition to its well-established link with the metabolic syndrome and increased risk for cardiovascular disease, NAFLD has also been associated with certain mental health issues (e.g., depression and stress). Although this link is now being increasingly recognized, there are still unmet needs regarding the holistic management of patients with NAFLD, which could further contribute to feelings of social isolation and loneliness. The latter conditions are also increasingly reported to pose a substantial risk to overall health and quality of life. To date, there is limited research that has explored these issues among patients with NAFLD, despite existing data which indicate that perceived loneliness and isolation may pose an additional health risk. Notably, many features associated with NAFLD have been related to these concepts, such as perceived stigma, fatigue, stress, and confusion regarding this diagnosis. As such, this review aimed to assess such potential problems faced by patients with NAFLD, and to explore the possibility of unmet support needs which could lead to perceived social isolation. Moreover, the importance of a compassionate approach towards such patients is discussed, together with potential coping strategies. Future research directions and the need for a multidisciplinary approach are also highlighted.

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 ).…”

“…Overall, NAFLD is a complex condition and may further be associated with various socioeconomic factors and unmet needs, which could in turn lead to mood imbalances and feelings of social isolation and loneliness, representing a further substantial risk to overall health and quality of life ( 28 ). Interestingly, chronic loneliness is reported as being associated with both mental health problems and metabolic disorders, potentially acting as a chronic stressor leading to HPA axis overactivity which may contribute to the development of both mental health and metabolic problems that, in turn, may also lead to feelings of social isolation ( 93 ).…”

“…However, further research is required to fully clarify the complete spectrum of such potential associations. Furthermore, it is plausible that certain features associated with NAFLD, such as lack of awareness regarding the condition, fatigue, and perceived stigma ( 13 , 25 – 27 ), may result in feelings of isolation and loneliness ( 28 ), which, in turn, may have a further impact on mental health and have been reported to be associated with cardio-metabolic disorders linked to NAFLD, including obesity, T2DM, metabolic syndrome, and CVD ( 29 , 30 ).…”

A global research priority agenda to advance public health responses to fatty liver disease

“…The panel felt strongly about the need to study the impact of treatment and care on overall quality of life, including functional status (priority 5.2; ranked 1st in its domain). Knowledge gaps remain about patient needs and experiences, 88 including perspectives around prevention, treatment, and care. The panel prioritised studies that can advance this understanding (priority 5.1; ranked 2nd in its domain).…”

Predictors for Health-seeking Behavior in Patients with Chronic Liver Disease: A Cross-Sectional Study from Pakistan

“…Mental health issues are a common problem facing CLD patients, and a cause for isolation and withdrawal in health-seeking [15]. The nancial burden for CLD patients is known to be associated with anxiety and depression [16], as well as worry and fatigue [17].…”