Antioxidant Lifestyle, Co-Morbidities and Quality of Life Empowerment Concerning Liver Fibrosis

Abstract

The assessment of liver fibrosis has gained importance since the progression of non-alcoholic fatty liver disease (NAFLD). Indeed, the description of the association between undetected liver fibrosis and lifestyle in terms of antioxidant habits, comorbidity and quality of life (QoL) domains may help in the characterization of subjects with NAFLD. A cross-sectional evaluation of (n = 116) consecutive patients from an Internal Medicine ambulatory evaluation was performed. Demographic data, lifestyle, co-morbidity, QoL (according to the SF-36 index) and analytical values to calculate the oxidative related Fibrosis-4 (FIB-4) index were recorded. The association between FIB-4 and co-morbidity, antioxidant habits in QoL was assessed in univariate analysis (p < 0.05) and confirmed in multivariable analysis for 4 of the 8 SF-36 categories: Physical QoL, Physical role, Social QoL and General QoL, as well as in the Physical summary of SF-36 (p < 0.05). Finally, interactions were assessed between co-morbidity, FIB-4 and antioxidant habits showed in the prediction of mean SF-36 (p < 0.01). Liver fibrosis assessed by the oxidative surrogate index FIB-4 is associated with the interaction between antioxidant lifestyle, co-morbidity and physical, social and general aspects of QoL in apparent liver disease-free individuals, generating a proof of concept for health empowerment and personalized medicine.

Keywords: antioxidant lifestyle; comorbidity; health empowerment; liver fibrosis; quality of life; redox status; wellbeing.

Figure 1

Fibrosis-4 (FIB-4) according to comorbidity, oxidative lifestyle and physical summary quality of life (QoL) SF-36. Antioxidant: Patients with 2 points in pro-oxidant lifestyle vs. rest of the population; Healthy: No diseases; Comorbid: At least 1 disease; Low physical QoL: Lowest tercile of SF-36 Physical summary. Statistical analysis: Comorbidity p = 0.01; Oxidative lifestyle p = 0.04; SF- 36 Physical Summary QoL p = 0.05.

Figure 2

Interaction between comorbidity, liver fibrosis probability according to FIB-4 and oxidative lifestyle in the prediction of QoL. QoL assessed by the mean of all 8 categories in SF-36; Low fibrosis probability: p < 50 of FIB-4; High fibrosis probability: p > 50 of FIB-4; Anti-oxidant lifestyle: 0 or 1 oxidative factors; Pro-oxidant lifestyle: 2 oxidative factors; Diseased: 1 or more co-morbidities. p for interaction between comorbidity, liver fibrosis and oxidative lifestyle < 0.001.