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. 2022 Sep 5;10(9):1699.
doi: 10.3390/healthcare10091699.

Reduced Quality of Life in Patients with Non-Alcoholic Fatty Liver Disease May Be Associated with Depression and Fatigue

Julia A Golubeva  1 , Anna F Sheptulina  1   2 , Adel A Yafarova  1 , Elvira M Mamutova  1 , Anton R Kiselev  3 , Oxana M Drapkina  1   2
Affiliations

Reduced Quality of Life in Patients with Non-Alcoholic Fatty Liver Disease May Be Associated with Depression and Fatigue

Julia A Golubeva et al. Healthcare (Basel). .

Abstract

Non-alcoholic fatty liver disease (NAFLD) is often thought of as clinically asymptomatic. However, many NAFLD patients complain of fatigue and low mood, which may affect their quality of life (QoL). This may create a barrier to weight loss and hinder the achievement of NAFLD therapy goals. Our study aimed to evaluate the QoL in NAFLD patients vs. healthy volunteers, and to analyze likely influencing factors. From March 2021 through December 2021, we enrolled 140 consecutive adult subjects (100 NAFLD patients and 40 controls). Overall, 95 patients with NAFLD and 37 controls were included in the final analysis. Fatty liver was diagnosed based on ultrasonographic findings. We employed 36-Item Short Form Health Survey (SF-36) to evaluate QoL, Hospital Anxiety and Depression Scale (HADS) to identify anxiety and/or depression, and Fatigue Assessment Scale (FAS) to measure fatigue. NAFLD patients had significantly lower physical component summary scores, as well as significantly higher HADS-D scores, compared with the control group (Mann-Whitney U criterion = 1140.0, p = 0.001 and U = 1294.5, p = 0.022, respectively). Likewise, fatigue was more common in NAFLD patients (χ2 = 4.008, p = 0.045). Impaired QoL was significantly associated with fatigue (FAS score ≥ 22, p < 0.001) and depression (HADS-D ≥ 8, p < 0.001). In conclusion, NAFLD patients had significantly poorer QoL vs. controls, in particular with respect to the physical component of health. Impaired QoL may be associated with fatigue and depression, and together they may interfere with increased physical activity and lifestyle modifications in patients with NAFLD.

Keywords: SF-36; depression; fatigue; lifestyle modifications; non-alcoholic fatty liver disease; quality of life.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Box Plot of the SF-36 questionnaire subscale values for patients with NAFLD (n = 95) and controls (n = 37). Physical functioning (A), role limitations due to physical health problems (B), bodily pain (C), and general health perceptions (D) comprise the physical component summary. Vitality (E), social functioning (F), role limitations due to personal or emotional problems (G), and mental health (H) comprise the mental component summary. Patients with NAFLD had significantly lower scores on all SF-36 categories, comprising the physical component summary score (i.e., physical functioning (A), role limitations due to physical health problems (B), bodily pain (C), and general health perceptions (D)). On the contrary, scores on the subscales, included in the mental component summary (i.e., vitality (E), social functioning (F), role limitations due to personal or emotional problems (G), and mental health (H)), tended to be higher in patients with NAFLD, though the differences did not reach statistically significant level. The line through the middle of each box represents the median. The length of the box thus represents the interquartile range. The error bars show the minimum and maximum values of each subscale. Outliers are depicted as circles. All comparisons are performed using Mann-Whitney U test. NS—non-significant.
Figure 1
Figure 1
Box Plot of the SF-36 questionnaire subscale values for patients with NAFLD (n = 95) and controls (n = 37). Physical functioning (A), role limitations due to physical health problems (B), bodily pain (C), and general health perceptions (D) comprise the physical component summary. Vitality (E), social functioning (F), role limitations due to personal or emotional problems (G), and mental health (H) comprise the mental component summary. Patients with NAFLD had significantly lower scores on all SF-36 categories, comprising the physical component summary score (i.e., physical functioning (A), role limitations due to physical health problems (B), bodily pain (C), and general health perceptions (D)). On the contrary, scores on the subscales, included in the mental component summary (i.e., vitality (E), social functioning (F), role limitations due to personal or emotional problems (G), and mental health (H)), tended to be higher in patients with NAFLD, though the differences did not reach statistically significant level. The line through the middle of each box represents the median. The length of the box thus represents the interquartile range. The error bars show the minimum and maximum values of each subscale. Outliers are depicted as circles. All comparisons are performed using Mann-Whitney U test. NS—non-significant.
Figure 2
Figure 2
Box Plot of the HADS-D (A) and HADS-A (B) score values for patients with NAFLD (n = 95) and controls (n = 37). Patients with NAFLD had significantly higher HADS-D scores, compared with the controls (A), whereas HADS-A scores did not differ substantially between the groups (B). The line through the middle of each box represents the median. The length of the box thus represents the interquartile range. The error bars show the minimum and maximum values of HADS-D and HADS-A scores. Outliers are depicted as circles. HADS-A—Hospital Anxiety and Depression Scale, subscale for anxiety; HADS-D—Hospital Anxiety and Depression Scale, subscale for depression. All comparisons are performed using Mann-Whitney U test. NS—non-significant.
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