title: Functional impairment in alcoholic liver disease and non-alcoholic fatty liver disease is significant and persists over 3 years of follow-up.
abstract: OBJECTIVE
  Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are common and increasing in prevalence. We examined prevalence and predictors of functional impairment in biopsy-proven ALD and NAFLD. Change in function over 3 years was explored.
  
  
  METHODS
  Validated functional, cognitive, autonomic, and fatigue symptom assessment tools were completed by patients who had attended our liver clinic.
  
  
  RESULTS
  Totals of 224 NAFLD and 107 ALD patients returned the assessment tools. NAFLD and ALD demonstrated comparable functional difficulties, which were significantly worse than controls (p < 0.001) with the proportion of participants experiencing difficulty significantly higher [x (2) 8.93(3), (p = 0.01)]. No significant functional difficulty was demonstrated between those participants who were pre-cirrhotic or cirrhotic. Independent associations were present between difficulty with function in ALD and higher burden of autonomic and cognitive symptoms (p = 0.02) and in NAFLD-increased cognitive difficulty (p < 0.0001), age (p = 0.001), fatigue (p = 0.01), lower albumin (p = 0.02), and bilirubin (p = 0.04). PHAQ scores increased 21 % 2008-2011 {(3.2/15.6) [15.6 (0-93.8)] to 18.75 (0-90.6)}. Functional difficulty of participants alive [15.6 (0-96.9)] was significantly less compared to those who died [40.6 (0-100)] (p = 0.02).
  
  
  CONCLUSIONS
  NAFLD and ALD patients experience significant functional impairment affecting activities of daily living that persists over time. This has implications for the management of liver disease and service provision.
authors.affiliation: UK NIHR Biomedical Research Centre in Ageing, Liver Theme, Clinical Academic Office, Medical School, Newcastle University, Newcastle, NE2 4HH, UK. Chris.Elliott@newcastle.ac.uk
authors.forename: Chris
authors.initials: C
authors.lastname: Elliott
authors.forename: James
authors.initials: J
authors.lastname: Frith
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Day
authors.forename: David E J
authors.initials: DE
authors.lastname: Jones
authors.forename: Julia L
authors.initials: JL
authors.lastname: Newton
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005234:Fatty Liver / Q000150:complications* / Q000473:pathology; D005235:Fatty Liver, Alcoholic / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D012893:Sleep Wake Disorders / Q000209:etiology