Quality of life in adults with nonalcoholic fatty liver disease: baseline data from the nonalcoholic steatohepatitis clinical research network

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States. 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.

Figure 1

Mean SF-36 PCS and MCS scores of adults enrolled in NASH CRN (n=713) and US normative sample with (n=1,982) and without (n=571) chronic illness. Error bars display standard deviations. Black bar = Mean scores of Individuals with NAFLD. Gray bar: Mean scores of general U.S. reference population. White bar with black diagonal lines: Mean scores of healthy (i.e., no chronic illness) reference sample. Mean PCS and MCS scores of NAFLD sample are significantly (P < 0.001) lower than PCS and MCS scores of general U.S. population and healthy sample

Figure 2

Mean SF-36 sub-scale scores of adults enrolled in NASH CRN (n=713) and US normative sample with (n=1,982) and without (n=571) chronic illness. Error bars display standard deviations. Black bar = Mean scores of Individuals with NAFLD. Gray bar: Mean scores of general U.S. reference population. White bar with black diagonal lines: Mean scores of healthy (i.e., no chronic illness) reference sample. PF: Physical Function; RP: Role-Physical; RE: Role-Emotional; VT: Vitality; MH: Mental Health; SF: Social Function; BP: Bodily Pain; GH: General Health. Mean subscale scores of NAFLD sample are significantly (P ≤ 0.001) lower than subscales scores of general U.S. population and healthy sample.

Figure 3

Median PCS scores and interquartile range by degree of fibrosis. ANOVA and Tukey’s post-hoc analysis demonstrated that PCS score for individuals with cirrhosis was significantly (P < 0.001) lower than each of the other groups.