title: Non-alcoholic fatty liver disease comorbid with major depressive disorder: The pathological features and poor therapeutic efficacy.
abstract: OBJECTIVE
  Major depressive disorder (MDD) is an important public health problem, and it is often comorbid with many chronic diseases. The purpose of this study was to identify the clinical features of non-alcoholic fatty liver disease (NAFLD) patients comorbid with MDD and to investigate the influence of MDD on the effect of treatment in patients with NAFLD.
  
  
  METHODS
  A total of 258 patients with biopsy-proven NAFLD were included. MDD was diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. The patients were followed up for 48 weeks under standard care for NAFLD, which consisted mainly of lifestyle modification.
  
  
  RESULTS
  There were 32 patients comorbid with MDD. They were characterized by more severe histological steatosis and higher NAFLD activity score, and also significantly higher levels of serum aminotransferase, γ-glutamyl transpeptidase and ferritin, than age-and-sex-matched NAFLD patients without MDD. Moreover, NAFLD patients with MDD showed poor response to the standard care for NAFLD, in body weight loss and in other parameters. Particularly, NAFLD patients with unstable MDD (not in full/partial remission) showed severe resistance to the treatment.
  
  
  CONCLUSIONS
  This is the first study to demonstrate the clinical features and response to therapy of NAFLD patients comorbid with MDD. The comorbid state of MDD was associated with more severe histological liver steatosis and worse treatment outcomes in patients with NAFLD. Further investigations are required to develop new lifestyle modification programs that enable NAFLD patients with MDD to achieve the treatment goal.
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Tomeno
authors.forename: Keigo
authors.initials: K
authors.lastname: Kawashima
authors.forename: Masato
authors.initials: M
authors.lastname: Yoneda
authors.forename: Satoru
authors.initials: S
authors.lastname: Saito
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Honda
authors.forename: Takaomi
authors.initials: T
authors.lastname: Kessoku
authors.forename: Kento
authors.initials: K
authors.lastname: Imajo
authors.forename: Hironori
authors.initials: H
authors.lastname: Mawatari
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.forename: Satoru
authors.initials: S
authors.lastname: Saito
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Hirayasu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology* / Q000628:therapy*; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: major depressive disorder; non-alcoholic fatty liver disease; steatohepatitis