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Lobular inflammation in NAFLD affects health-related quality of life

The presence of lobular inflammation in patients with nonalcoholic fatty liver disease correlated with a lower health-related quality of life, along with sex and diabetes, according to a recently published study.

“[Health-related quality of life (HRQL)] is an important facet when assessing the burden of a chronic disease. Despite the lack of specific symptoms in liver disease, patients can experience impairment in the quality of life at an individual level,” Yvonne Huber, MD, from the Johannes Guttenberg-University Mainz in Germany, and colleagues wrote. “It can be expected that improvement of steatohepatitis — and in particular lobular inflammation — will have measurable influence on HRQL even independently of fibrosis improvement.”

To assess the effects of NAFLD on HRQL, Huber and colleagues examined the self-reported outcomes of 304 patients from European centers using the Chronic Liver Disease Questionnaire (CLDQ).

The mean CLDQ score was 4.99 for the entire cohort. The lowest scores were in the subcategory “fatigue” (4.31) followed by “emotional functioning” (4.93), while the highest scores were in the subcategories “abdominal symptoms” (5.33) and “activity” (5.43).

Compared with men, women had a significantly lower overall CLDQ scores (4.62 vs. 5.31; P < .001) and lower scores in the abdominal symptoms, fatigue, systemic symptoms, activity, emotional functioning, and worry scores (P < .01).

“Women scored lower in all subcategories of the CLDQ across all countries, indicating that the burden of disease in women could be higher,” the researchers wrote. “This effect was not explained by disease activity or advanced stage. Interestingly, these findings are replicated in studies on [hepatitis C] and HIV coinfected patients that also showed significantly lower HRQL in women. Thus, it seems plausible that CLDQ has a higher sensitivity to detect impairment in the quality of life in women compared to men.”

CLDQ scores also correlated negatively with the presence of obesity (P < .001), diabetes type 2 (P < .001) and dyslipidemia (P < .01).

Looking at the 210 patients with nonalcoholic steatohepatitis, the researchers found that NASH correlated with a lower overall HRQL than patients with NAFLD (4.85 vs. 5.31; P < .01) and with lower all CLDQ subcategory scores except for abdominal symptoms and emotional function.

“As NAFLD is a highly prevalent disease that causes a distinct loss in HRQL and eventually also poses an economic burden, a high priority should be placed on prevention and treatment,” Huber and colleagues concluded. “With the emergence of medical therapy, the improvement in HRQL will likely influence the choice of drug in the future.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.