Poorer health-related quality of life in NAFLD patients compared to the general population

LONDON — Non-alcoholic patients fatty liver had a poorer health-related quality of life, regardless of fibrosis stage, compared to the general population, according to a study presented at the International Liver Congress.

“Health-related quality of life has been shown to be impaired in NAFLD patients and potentially associated with the severity of fibrosis, obesity or other metabolic comorbidities,” Marguerite Papatheodoridi, MD, PhD, said a postdoctoral researcher at the Royal Free Hospital Institute for Liver and Digestive Health at the University College of London. “It remains unclear whether quality of life is impaired in NAFLD patients without advanced fibrosis or cirrhosis compared to the general population and whether these alterations are due to the presence of fibrosis or other liver comorbidities.”

In a multicentre prospective study, 561 patients with NAFLD from four UK secondary care centers completed the EQ-5D-5L questionnaire and the Chronic Liver Disease Questionnaire (CLDQ) between 2016 and 2019 to assess the quality of life. Papatheodoridi and colleagues also collected patient information regarding demographics and clinical history, liver stiffness, liver biopsy results, and history of cirrhosis.

The researchers used propensity score matching and reports from a subcohort survey of the general population of people without alcohol abuse to compare health-related quality of life (HRQL). The primary endpoint was the assessment of HRQoL in patients with NAFLD compared to the general population; secondary endpoints included the association of fibrosis severity and metabolic comorbidities with HRQOL disorders.

According to the study results, 514 NAFLD patients had lower EQ-5D-5L index scores than 514 propensity-matched healthy controls (0.762 ± 0.276 versus 0.844 ± 0.2); this difference was also evident in a subgroup of NAFLD patients without advanced fibrosis compared to the general population (0.781 ± 0.276 vs 0.845 ± 0.2). Compared to patients with NAFLD without cirrhosis, patients with NAFLD and cirrhosis had lower EQ-5D-5L, visual analog scale (VAS), and CLDQ scores.

The researchers found no difference between patients with nonalcoholic steatohepatitis regardless of advanced fibrosis, but associated liver stiffness with lower HRQL scores in the overall patient population and in patients without cirrhosis. .

Multivariate analysis further showed that the EQ-5D-5L index was negatively correlated with type 2 diabetes, depression, and osteoarthritis among the entire patient population as well as patients without cirrhosis. and EQ-VAS associated with age, sex, BMI, depression and osteoarthritis.

Lower CLDQ scores correlated with younger age, male gender, type 2 diabetes, ischemic heart disease, depression and osteoarthritis in all patients and lower CLDQ scores correlated with male gender, type 2 diabetes 2 and depression in the subgroup of patients without cirrhosis.

“HRQOL is similar for NASH patients with and without advanced fibrosis and HRQOL is independently associated with non-hepatic comorbidities but not liver stiffness,” Papatheodoridi concluded. “Multidisciplinary care is necessary for all NAFLD patients, regardless of disease severity.”

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International Liver Congress