EVALUATION OF THE CORRELATION BETWEEN DISEASE SEVERITY AND QUALITY OF LIFE IN NON ALCOHOLIC FATTY LIVER PATIENTS

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease strongly linked with obesity, type 2 diabetes mellitus, dyslipidemia and metabolic syndrome. A progression of disease from simple steatosis to severe fibrosis is accompanied by a marked decline in health-related quality of life (HRQoL). So, this study tried to investigate the relationship between the severity of NAFLD and HRQoL with a particular focus on the effect of hepatic fibrosis. Materials and Methods: This was a prospective observational study involving 466 adult patients with NAFLD at the Government General Hospital, Anantapur. Severity of the disease was evaluated by Fatty liver index (FLI) and Fibrosis-4 (FIB-4) score, and health related quality of life (HRQoL) by validated questionnaires including Chronic Liver Disease Questionnaire for NAFLD (CLDQ-NAFLD) and Short Form-36 (SF-36). Correlation and stepwise multiple linear regression analyses were conducted to assess disease severity in relation to HRQoL. Results: The average scores of FLI and FIB-4 were 56.4 ± 13.5 and 2.3 ± 0.7, respectively. Among the subjects, high-risk steatosis and fibrosis were 66.5% and 72.3%, respectively. Advanced fibrosis patients had significantly worse HRQoL in all domains measured like physical functioning, fatigue, emotional well-being, activity restriction, and the quality of life in general; p < 0.001. The strongest inverse association of fibrosis severity was with overall HRQoL (r = –0.48, p < 0.001) as followed by steatosis severity (r = –0.36, p < 0.001). Several linear regression analysis revealed fibrosis severity (β = 0.41, p < 0.001), HbA1c (β = –0.24, p = 0.003), and BMI (β = –0.19, p = 0.008) as significant predictors of poor HRQoL. Conclusion: Progressive liver fibrosis is independently associated with substantial impairment in HRQoL in NAFLD patients and accounts for the greatest impairment in patient well-being. Early detection of fibrosis by non-invasive techniques in conjunction with optimal metabolic treatment and multidisciplinary approach may have beneficial effects on clinical outcome and quality of life.