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. 2021 Oct;41(10):2295-2307.
doi: 10.1111/liv.14969. Epub 2021 Jun 8.

A Twitter discourse analysis of negative feelings and stigma related to NAFLD, NASH and obesity

Jeffrey V Lazarus  1 , Christine Kakalou  2 , Adam Palayew  3 , Christina Karamanidou  2 , Christos Maramis  2 , Pantelis Natsiavas  2 , Camila A Picchio  1 , Marcela Villota-Rivas  1 , Shira Zelber-Sagi  4   5 , Patrizia Carrieri  6
Affiliations

A Twitter discourse analysis of negative feelings and stigma related to NAFLD, NASH and obesity

Jeffrey V Lazarus et al. Liver Int. 2021 Oct.

Abstract

Background: People with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are stigmatized, partly since 'non-alcoholic' is in the name, but also because of obesity, which is a common condition in this group. Stigma is pervasive in social media and can contribute to poorer health outcomes. We examine how stigma and negative feelings concerning NAFLD/NASH and obesity manifest on Twitter.

Methods: Using a self-developed search terms index, we collected NAFLD/NASH tweets from May to October 2019 (Phase I). Because stigmatizing NAFLD/NASH tweets were limited, Phase II focused on obesity (November-December 2019). Via sentiment analysis, >5000 tweets were annotated as positive, neutral or negative and used to train machine learning-based Natural Language Processing software, applied to 193 747 randomly sampled tweets. All tweets collected were analysed.

Results: In Phase I, 16 835 tweets for NAFLD and 2376 for NASH were retrieved. Of the annotated NAFLD/NASH tweets, 97/1130 (8.6%) and 63/535 (11.8%), respectively, related to obesity and 13/1130 (1.2%) and 5/535 (0.9%), to stigma; they primarily focused on scientific discourse and unverified information. Of the 193 747 non-annotated obesity tweets (Phase II), the algorithm classified 40.0% as related to obesity, of which 85.2% were negative, 1.0% positive and 13.7% neutral.

Conclusions: NAFLD/NASH tweets mostly indicated an unmet information need and showed no clear signs of stigma. However, the negative content of obesity tweets was recurrent. As obesity-related stigma is associated with reduced care engagement and lifestyle modification, the main NAFLD/NASH treatment, stigma-reducing interventions in social media should be included in the liver health agenda.

Keywords: Twitter; liver disease; social media; stigma.

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Comment in

  • [Letter to the Editor].
    Pieri D, Pipitone S, Rubino A. Pieri D, et al. G Ital Cardiol (Rome). 2022 Mar;23(3):229. doi: 10.1714/3751.37343. G Ital Cardiol (Rome). 2022. PMID: 35343505 Italian. No abstract available.

References

REFERENCES

    1. Williams CD, Stengel J, Asike MI, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140(1):124-131.
    1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73-84.
    1. Ekstedt M, Nasr P, Kechagias S. Natural history of NAFLD/NASH. Curr Hepatol Rep. 2017;16(4):391-397.
    1. Calzadilla Bertot L, Adams LA. The natural course of non-Alcoholic fatty liver disease. Int J Mol Sci. 2016;17(5):774.
    1. Younossi Z, Tacke F, Arrese M, et al. Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Hepatology. 2019;69(6):2672-2682.

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