title: Non-alcoholic fatty liver disease is not associated with a lower health perception.
abstract: OBJECTIVE
  To examine the association between non-alcoholic fatty liver disease (NAFLD) and general health perception.
  
  
  METHODS
  This cross sectional and prospective follow-up study was performed on a cohort of a sub-sample of the first Israeli national health and nutrition examination survey, with no secondary liver disease or history of alcohol abuse. On the first survey, in 2003-2004, 349 participants were included. In 2009-2010 participants from the baseline survey were invited to participate in a follow-up survey. On both baseline and follow-up surveys the data collected included: self-reported general health perception, physical activity habits, frequency of physician's visits, fatigue impact scale and abdominal ultrasound. Fatty liver was diagnosed by abdominal ultrasonography using standardized criteria and the ratio between the median brightness level of the liver and the right kidney was calculated to determine the Hepato-Renal Index.
  
  
  RESULTS
  Out of 349 eligible participants in the first survey, 213 volunteers participated in the follow-up cohort and were included in the current analysis, NAFLD was diagnosed in 70/213 (32.9%). The prevalence of "very good" self-reported health perception was lower among participants diagnosed with NAFLD compared to those without NAFLD. However, adjustment for BMI attenuated the association (OR = 0.73, 95%CI: 0.36-1.50, P = 0.392). Similar results were observed for the hepato-renal index; it was inversely associated with "very good" health perception but adjustment for BMI attenuated the association. In a full model of multivariate analysis, that included all potential predictors for health perception, NAFLD was not associated with the self-reported general health perception (OR = 0.86, 95%CI: 0.40-1.86, P = 0.704). The odds for "very good" self-reported general health perception (compared to "else") increased among men (OR = 2.42, 95%CI: 1.26-4.66, P = 0.008) and those with higher performance of leisure time physical activity (OR = 1.01, 95%CI: 1.00-1.01, P < 0.001, per every minute/week) and decreased with increasing level of BMI (OR = 0.91, 95%CI: 0.84-0.99, P = 0.028, per every kg/m(2)) and older age (OR = 0.96, 95%CI: 0.93-0.99, P = 0.033, per one year). Current smoking was not associated with health perception (OR = 1.31, 95%CI: 0.54-3.16, P = 0.552). Newly diagnosed (naive) and previously diagnosed (at the first survey, not naive) NAFLD patients did not differ in their self-health perception. The presence of NAFLD at the first survey as compared to normal liver did not predict health perception deterioration at the 7 years follow-up. In terms of health-services utilization, subjects diagnosed with NAFLD had a similar number of physician's visits (general physicians and specialty consultants) as in the normal liver group. Parameters in the fatigue impact scale were equivalent between the NAFLD and the normal liver groups.
  
  
  CONCLUSIONS
  Fatty liver without clinically significant liver disease does not have independent impact on self-health perception.
authors.affiliation: Liat Mlynarsky, Roni Lotan, Muriel Webb, Zamir Halpern, Erwin Santo, Oren Shibolet, Shira Zelber-Sagi, Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv 6423906, Israel.
authors.forename: Liat
authors.initials: L
authors.lastname: Mlynarsky
authors.affiliation: Liat Mlynarsky, Roni Lotan, Muriel Webb, Zamir Halpern, Erwin Santo, Oren Shibolet, Shira Zelber-Sagi, Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv 6423906, Israel.
authors.forename: Dalit
authors.initials: D
authors.lastname: Schlesinger
authors.affiliation: Liat Mlynarsky, Roni Lotan, Muriel Webb, Zamir Halpern, Erwin Santo, Oren Shibolet, Shira Zelber-Sagi, Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv 6423906, Israel.
authors.forename: Roni
authors.initials: R
authors.lastname: Lotan
authors.affiliation: Liat Mlynarsky, Roni Lotan, Muriel Webb, Zamir Halpern, Erwin Santo, Oren Shibolet, Shira Zelber-Sagi, Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv 6423906, Israel.
authors.forename: Muriel
authors.initials: M
authors.lastname: Webb
authors.affiliation: Liat Mlynarsky, Roni Lotan, Muriel Webb, Zamir Halpern, Erwin Santo, Oren Shibolet, Shira Zelber-Sagi, Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv 6423906, Israel.
authors.forename: Zamir
authors.initials: Z
authors.lastname: Halpern
authors.affiliation: Liat Mlynarsky, Roni Lotan, Muriel Webb, Zamir Halpern, Erwin Santo, Oren Shibolet, Shira Zelber-Sagi, Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv 6423906, Israel.
authors.forename: Erwin
authors.initials: E
authors.lastname: Santo
authors.affiliation: Liat Mlynarsky, Roni Lotan, Muriel Webb, Zamir Halpern, Erwin Santo, Oren Shibolet, Shira Zelber-Sagi, Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv 6423906, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Shibolet
authors.affiliation: Liat Mlynarsky, Roni Lotan, Muriel Webb, Zamir Halpern, Erwin Santo, Oren Shibolet, Shira Zelber-Sagi, Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv 6423906, Israel.
authors.forename: Shira
authors.initials: S
authors.lastname: Zelber-Sagi
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D015444:Exercise; D005221:Fatigue / Q000209:etiology; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000209:etiology*; D010465:Perception; D011446:Prospective Studies
keywords: Fatigue; Health perception; Health-care services utilization; Non-alcoholic fatty liver disease; Quality of life