Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia; Medicine Service Line, Inova Health Sytem, Falls Church, Virginia.
Department of Gastroenterology, School of Medicine, Istanbul, Turkey; Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
Clin Gastroenterol Hepatol. 2022 Oct;20(10):2296-2306.e6. doi: 10.1016/j.cgh.2021.11.004. Epub 2021 Nov 9.
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.
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.
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).
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.
在全球范围内，非酒精性脂肪性肝病（NAFLD）是一种常见的慢性肝病病因。我们评估了来自不同国家的 NAFLD 患者的临床表现和患者报告的结局（PROs）。
临床、实验室和 PRO 数据（非酒精性脂肪性肝炎[NASH]慢性肝病问卷、慢性疾病治疗疲劳功能评估量表和工作生产力和活动指数）是从全球范围内 18 个国家的真实实践中观察到的 NAFLD 患者中收集的，并纳入了涵盖全球 6 个疾病负担超级区域的全球 NAFLD/NASH 登记处。
在全球疾病负担超级区域中，NAFLD 患者（n=5691）年龄最大的是拉丁美洲和东欧，年龄最小的是南亚。大多数男性在东南亚和南亚的研究点入组。拉丁美洲和南亚的就业率最高（>60%）。肝硬化的发生率各不相同（12%-21%），北非/中东和东欧最高。代谢综合征成分的发生率也各不相同：南亚为 20%-25%，东欧为 60%-80%。NAFLD 患者的 NASH 慢性肝病问卷和慢性疾病治疗疲劳功能评估量表 PRO 评分均低于一般人群的正常值（均 P <0.001）。在所有超级区域中，PRO 评分最低的是东欧和北非/中东。在调整了入组区域的多变量分析中，PRO 评分较低的独立预测因素包括年龄较小、女性以及非肝脏合并症，包括疲劳（P <0.01）。随着时间的推移，疲劳评分改善的患者经历了显著的 PRO 改善。全球 NAFLD/NASH 登记处近 8%的患者体脂率较低，合并症较少，代谢综合征成分较少，肝硬化较少，PRO 评分显著改善（P <0.01）。
在不同国家的真实实践中观察到的 NAFLD 患者患有较高的合并症负担和较差的生活质量。未来使用全球数据的研究将为这些患者提供更精确的管理和治疗策略。
