Clinical and Patient-Reported Outcomes From Patients With Nonalcoholic Fatty Liver Disease Across the World: Data From the Global Non-Alcoholic Steatohepatitis (NASH)/ Non-Alcoholic Fatty Liver Disease (NAFLD) Registry

Zobair M Younossi; Yusuf Yilmaz; Ming-Lung Yu; Vincent Wai-Sun Wong; Marlen Castellanos Fernandez; Vasily A Isakov; Ajay K Duseja; Nahum Mendez-Sanchez; Yuichiro Eguchi; Elisabetta Bugianesi; Patrizia Burra; Jacob George; Jian-Gao Fan; George V Papatheodoridis; Wah Kheong Chan; Khalid Alswat; Hamid S Saeed; Ashwani K Singal; Manuel Romero-Gomez; Stuart C Gordon; Stuart K Roberts; Mohamed El Kassas; Marcelo Kugelmas; Janus P Ong; Saleh Alqahtani; Mariam Ziayee; Brian Lam; Issah Younossi; Andrei Racila; Linda Henry; Maria Stepanova; Global NASH Council

doi:10.1016/j.cgh.2021.11.004

Clinical and Patient-Reported Outcomes From Patients With Nonalcoholic Fatty Liver Disease Across the World: Data From the Global Non-Alcoholic Steatohepatitis (NASH)/ Non-Alcoholic Fatty Liver Disease (NAFLD) Registry

Clin Gastroenterol Hepatol. 2022 Oct;20(10):2296-2306.e6. doi: 10.1016/j.cgh.2021.11.004. Epub 2021 Nov 9.

Authors

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; Global NASH Council

Affiliations

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: [email protected].
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.

PMID: 34768009
DOI: 10.1016/j.cgh.2021.11.004

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.

Keywords: Chronic Diseases; Disease Burden; Metabolic Syndrome; Outcomes; Work Productivity.

MeSH terms

Chronic Disease
Fatigue
Female
Fibrosis
Humans
Liver Cirrhosis
Male
Metabolic Syndrome* / epidemiology
Non-alcoholic Fatty Liver Disease* / epidemiology
Patient Reported Outcome Measures
Prevalence
Quality of Life
Registries