Original article
Pancreas, biliary tract, and liver
Health-related Quality of Life in Nonalcoholic Fatty Liver Disease Associates With Hepatic Inflammation

https://doi.org/10.1016/j.cgh.2018.12.016Get rights and content

Background & Aims

Chronic liver disease has negative effects on health-related quality of life (HRQL). We analyzed data from the European non-alcoholic fatty liver disease (NAFLD) registry to assess the effects of NAFLD on HRQL.

Methods

We collected data from 304 patients (mean age, 52.3 ± 12.9 years) with histologically defined NAFLD enrolled prospectively into the European NAFLD Registry in Germany, the United Kingdom, and Spain. The chronic liver disease questionnaire (CLDQ) was completed within 6 months of liver biopsy collection.

Results

The mean CLDQ overall score was 5.0 ± 1.2, with the lowest score in the category fatigue (4.3 ± 1.6) and the highest scores for activity (5.4 ± 1.4). Women had significantly lower CLDQ scores than men (4.6 ± 1.3 vs 5.3 ± 1.1; P < .001). We found negative correlations between CLDQ scores and presence of obesity (P < .001), type 2 diabetes (P < .001), and dyslipidaemia (P < .01). There was a negative correlation between level of aspartate aminotransferase, but not alanine aminotransferase, and HRQL. Higher histological score of steatosis (1 vs 3) resulted in lower mean CLDQ score (5.3 ± 1.1 vs 4.5 ± 1.4; P < .01); higher level of lobular inflammation (0 vs 3) also resulted in lower mean CLDQ score (5.3 ± 1.2 vs 3.9 ± 1.8; P <. 001). In contrast, advanced fibrosis (F3–4) compared to early or intermediate fibrosis (F0–2) had no significant effect on mean CLDQ score (4.9 ± 1.2 vs 5.1 ± 1.3; P = .072). In multivariate analysis, patients sex, age, presence of type 2 diabetes, and inflammation were independently associated with low HRQL.

Conclusion

In an analysis of data from the European NAFLD registry, we observed a substantial burden of symptoms in patients. In addition to age, sex, and the presence of diabetes, detection of lobular inflammation in biopsies correlated with lower HRQL.

Section snippets

Patient Characteristics

Patients with NAFLD were recruited at the University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany, at the Freeman Hospital Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom (UK), and at the University Hospital of the University of Seville, Spain, as part of the prospectively enrolling European NAFLD Registry, after written informed consent. Permission was obtained from the respective ethical commissions: Ethikkommission der

Patient Characteristics

A total of 304 patients were included in the study, 154 from the UK, 133 from Germany, and 17 from Spain. The mean age was 52.3 (±12.9) years, and 53.3% (n = 162) were male. The majority of patients (n = 228, 75.0%) were obese, with a median BMI of 33.3 kg/m2 (interquartile range, 30.0–37.5). Demographic data, characteristics of liver function, histopathological features, and differences between the countries are presented in Table 1. The majority of patients had moderate steatosis (grade 2,

Discussion

The current study explored HRQL in patients with biopsy proven NAFLD from 3 European centers. HRQL is an important facet when assessing the burden of a chronic disease. Despite the lack of specific symptoms in liver disease, patients can experience impairment in the quality of life at an individual level.27 In patients with NAFLD and other chronic liver disease, fatigue and impaired sleeping quality are the most frequently reported findings.12, 27, 28 Likewise, the number of comorbidities and

Acknowledgments

The authors thank the patients who were participating in the European NAFLD Registry.

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    Conflicts of interest The authors disclose no conflicts.

    Funding This work was funded by H2020 under grant no. 634413 for the EPoS project and the Newcastle NIHR Biomedical Research Centre.

    b

    Authors share co-senior authorship.

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