Zobair M Younossi1, Yusuf Yilmaz2, Ming-Lung Yu3, Vincent Wai-Sun Wong4, Marlen Castellanos Fernandez5, Vasily A Isakov6, Ajay K Duseja7, Nahum Mendez-Sanchez8, Yuichiro Eguchi9, Elisabetta Bugianesi10, Patrizia Burra11, Jacob George12, Jian-Gao Fan13, George V Papatheodoridis14, Wah Kheong Chan15, Khalid Alswat16, Hamid S Saeed17, Ashwani K Singal18, Manuel Romero-Gomez19, Stuart C Gordon20, Stuart K Roberts21, Mohamed El Kassas22, Marcelo Kugelmas23, Janus P Ong24, Saleh Alqahtani25, Mariam Ziayee26, Brian Lam27, Issah Younossi28, Andrei Racila27, Linda Henry29, Maria Stepanova29. 1. Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia; Medicine Service Line, Inova Health Sytem, Falls Church, Virginia. Electronic address: Zobair.Younossi@inova.org. 2. Department of Gastroenterology, School of Medicine, Istanbul, Turkey; Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey. 3. Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan. 4. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong. 5. Institute of Gastroenterology, University of Medical Sciences of Havana, Havana, Cuba. 6. Federal Research Center of Nutrition, Biotechnology and Food Safety, Moscow, Russia. 7. Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 8. Liver Research Unit, Medica Sur Clinic and Foundation, National Autonomous University of Mexico, Mexico City, Mexico. 9. Locomedical General Institute, Locomedical Medical Cooperation, Ogi, Saga, Japan. 10. Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, Italy. 11. Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy. 12. Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Australia. 13. Xinhua Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China. 14. National and Kapodistrian University of Athens, Greece. 15. Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 16. Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Saudi Arabia. 17. Department of Medicine, Aga Khan University, Karachi, Pakistan. 18. University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota. 19. Digestive Diseases Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Spain. 20. Henry Ford Hospital System, Department Gastroenterology and Hepatology, Wayne State University School of Medicine, Detroit, Michigan. 21. The Alfred, Department of Hepatology and Gastroenterology, Monash University, Melbourne Victoria, Australia. 22. Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt. 23. South Denver Gastroenterology, PC, Denver, Colorado. 24. University of the Philippines, College of Medicine, Manila, Philippines; Center for Outcomes Research in Liver Disease, Washington District of Columbia, Riyadh, Saudi Arabia. 25. King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia. 26. Center for Outcomes Research in Liver Disease, Washington District of Columbia, Riyadh, Saudi Arabia. 27. Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia; Medicine Service Line, Inova Health Sytem, Falls Church, Virginia; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia. 28. Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia. 29. Center for Outcomes Research in Liver Disease, Washington District of Columbia, Riyadh, Saudi Arabia; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia.
Abstract
BACKGROUND & AIMS: Globally, nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. We assessed the clinical presentation and patient-reported outcomes (PROs) among NAFLD patients from different countries. METHODS: Clinical, laboratory, and PRO data (Chronic Liver Disease Questionnaire-nonalcoholic steatohepatitis [NASH], Functional Assessment of Chronic Illness Therapy-Fatigue, and the Work Productivity and Activity Index) were collected from NAFLD patients seen in real-world practices and enrolled in the Global NAFLD/NASH Registry encompassing 18 countries in 6 global burden of disease super-regions. RESULTS: Across the global burden of disease super-regions, NAFLD patients (n = 5691) were oldest in Latin America and Eastern Europe and youngest in South Asia. Most men were enrolled at the Southeast and South Asia sites. Latin America and South Asia had the highest employment rates (>60%). Rates of cirrhosis varied (12%-21%), and were highest in North Africa/Middle East and Eastern Europe. Rates of metabolic syndrome components varied: 20% to 25% in South Asia and 60% to 80% in Eastern Europe. Chronic Liver Disease Questionnaire-NASH and Functional Assessment of Chronic Illness Therapy-Fatigue PRO scores were lower in NAFLD patients than general population norms (all P < .001). Across the super-regions, the lowest PRO scores were seen in Eastern Europe and North Africa/Middle East. In multivariate analysis adjusted for enrollment region, independent predictors of lower PRO scores included younger age, women, and nonhepatic comorbidities including fatigue (P < .01). Patients whose fatigue scores improved over time experienced a substantial PRO improvement. Nearly 8% of Global NAFLD/NASH Registry patients had a lean body mass index, with fewer metabolic syndrome components, fewer comorbidities, less cirrhosis, and significantly better PRO scores (P < .01). CONCLUSIONS: NAFLD patients seen in real-world practices in different countries experience a high comorbidity burden and impaired quality of life. Future research using global data will enable more precise management and treatment strategies for these patients.
BACKGROUND & AIMS: Globally, nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. We assessed the clinical presentation and patient-reported outcomes (PROs) among NAFLD patients from different countries. METHODS: Clinical, laboratory, and PRO data (Chronic Liver Disease Questionnaire-nonalcoholic steatohepatitis [NASH], Functional Assessment of Chronic Illness Therapy-Fatigue, and the Work Productivity and Activity Index) were collected from NAFLD patients seen in real-world practices and enrolled in the Global NAFLD/NASH Registry encompassing 18 countries in 6 global burden of disease super-regions. RESULTS: Across the global burden of disease super-regions, NAFLD patients (n = 5691) were oldest in Latin America and Eastern Europe and youngest in South Asia. Most men were enrolled at the Southeast and South Asia sites. Latin America and South Asia had the highest employment rates (>60%). Rates of cirrhosis varied (12%-21%), and were highest in North Africa/Middle East and Eastern Europe. Rates of metabolic syndrome components varied: 20% to 25% in South Asia and 60% to 80% in Eastern Europe. Chronic Liver Disease Questionnaire-NASH and Functional Assessment of Chronic Illness Therapy-Fatigue PRO scores were lower in NAFLD patients than general population norms (all P < .001). Across the super-regions, the lowest PRO scores were seen in Eastern Europe and North Africa/Middle East. In multivariate analysis adjusted for enrollment region, independent predictors of lower PRO scores included younger age, women, and nonhepatic comorbidities including fatigue (P < .01). Patients whose fatigue scores improved over time experienced a substantial PRO improvement. Nearly 8% of Global NAFLD/NASH Registry patients had a lean body mass index, with fewer metabolic syndrome components, fewer comorbidities, less cirrhosis, and significantly better PRO scores (P < .01). CONCLUSIONS: NAFLD patients seen in real-world practices in different countries experience a high comorbidity burden and impaired quality of life. Future research using global data will enable more precise management and treatment strategies for these patients.