1Center 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.
2Department of Gastroenterology, School of Medicine, Istanbul, Turkey; Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
3Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
4Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
5Institute of Gastroenterology, University of Medical Sciences of Havana, Havana, Cuba.
6Federal Research Center of Nutrition, Biotechnology and Food Safety, Moscow, Russia.
7Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
8Liver Research Unit, Medica Sur Clinic and Foundation, National Autonomous University of Mexico, Mexico City, Mexico.
9Locomedical General Institute, Locomedical Medical Cooperation, Ogi, Saga, Japan.
10Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, Italy.
11Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
12Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Australia.
13Xinhua Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China.
14National and Kapodistrian University of Athens, Greece.
15Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
16Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Saudi Arabia.
17Department of Medicine, Aga Khan University, Karachi, Pakistan.
18University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
19Digestive Diseases Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Spain.
20Henry Ford Hospital System, Department Gastroenterology and Hepatology, Wayne State University School of Medicine, Detroit, Michigan.
21The Alfred, Department of Hepatology and Gastroenterology, Monash University, Melbourne Victoria, Australia.
22Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
23South Denver Gastroenterology, PC, Denver, Colorado.
24University of the Philippines, College of Medicine, Manila, Philippines; Center for Outcomes Research in Liver Disease, Washington District of Columbia, Riyadh, Saudi Arabia.
25King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia.
26Center for Outcomes Research in Liver Disease, Washington District of Columbia, Riyadh, Saudi Arabia.
27Center 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.
28Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia.
29Center 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.
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.