title: Non-alcoholic Fatty Liver Disease (NAFLD) is associated with impairment of Health Related Quality of Life (HRQOL).
abstract: BACKGROUND
  NAFLD impacts patient reported outcomes (PROs). Our aim was to assess the impact of NAFLD on patients' HRQOL.
  
  
  METHODS
  National Health and Nutrition Examination Survey (NHANES) 2001-2011 data were used to identify adult patients with NAFLD [Fatty Liver Index (FLI) > 60 in absence of other liver disease and excessive alcohol >20 g/day for men, >10 g/day for women]. Patients with other chronic diseases (ex. HIV, cancer, end-stage kidney disease) were excluded. Subjects without any of these conditions were healthy controls. HCV RNA (+) patients were HCV-controls. All patients completed NHANES HRQOL-4 questionnaire. Linear regression determined the association between NAFLD and HRQOL components adjusting for age, gender, race, and BMI.
  
  
  RESULTS
  Participants with complete data were included (n = 9661); 3333 NAFLD (age 51 years and BMI 34 kg/m(2)); 346 HCV+ (age 49 years; BMI 27 kg/m(2)) and 5982 healthy controls (age 48 years and BMI 26 kg/m(2)). The proportion of subjects rating their health as "fair" or "poor" in descending order were HCV controls (30 %) NAFLD (20 %) and healthy controls (10 %) (p < 0.001). HRQOL-4 components scores 2-4 were lowest for HCV, followed by NAFLD and then healthy controls (p-values p = 0.011 to < .0001). After adjustment for age, gender, race, and BMI, NAFLD patients were 18-20 % more likely to report days when their physical health wasn't good or were unable to perform daily activities as a result (p < .0001).
  
  
  CONCLUSIONS
  NAFLD causes impairment of HRQOL. As NAFLD is becoming the most important cause of CLD, its clinical and PRO impact must be assessed.
authors: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA. pegah.golabi@inova.org.
authors: Pegah
authors: P
authors: Golabi
authors: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA. munkhzul.otgonsuren@inova.org.
authors: Munkhzul
authors: M
authors: Otgonsuren
authors: Center For Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. rebecca.cable@inova.org.
authors: Rebecca
authors: R
authors: Cable
authors: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA. sean.felix@inova.org.
authors: Sean
authors: S
authors: Felix
authors: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA. koenigab@gmail.com.
authors: Aaron
authors: A
authors: Koenig
authors: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA. mehmet.sayiner@inova.org.
authors: Mehmet
authors: M
authors: Sayiner
authors: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA. Zobair.younossi@inova.org.|Center For Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. Zobair.younossi@inova.org.
authors: Zobair M
authors: ZM
authors: Younossi
mesh_terms: D000223:Adaptation, Psychological; D000367:Age Factors; D001294:Attitude to Health; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000523:psychology*; D009749:Nutrition Surveys; D011788:Quality of Life / Q000523:psychology*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014481:United States