Patients With Nonalcoholic Steatohepatitis Experience Severe Impairment of Health-Related Quality of Life

Zobair M. Younossi, Maria Stepanova, Eric J. Lawitz, K. Rajender Reddy, Vincent Wai-Sun Wong, Alessandra Mangia, Andrew J. Muir, Ira Jacobson, C. Stephen Djedjos, Anuj Gaggar, Robert P. Myers, Issah Younossi, Fatema Nader, Andrei Racila

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Although there is substantial evidence suggesting poor health-related quality of life (HRQL) in patients with chronic hepatitis C (CHC), similar data in nonalcoholic steatohepatitis (NASH) have not been fully assessed. The aim is to compare HRQL scores in patients with CHC to those with NASH. METHODS: Matched patients with advanced fibrosis (bridging fibrosis and compensated cirrhosis) due to CHC and NASH completed Short Form-36 (SF-36) questionnaire, Chronic Liver Disease Questionnaire (CLDQ), and Work Productivity and Activity Instrument questionnaire. RESULTS: We included 1,338 patients with NASH with advanced fibrosis (mean age 57.2 years, 47% men, 55% cirrhosis) and 1,338 matched patients with CHC. Patients with CHC and NASH had similar rates of employment and psychiatric disorders (P > 0.05). As expected, patients with NASH had higher body mass index (mean 33.7 vs 27.6) and more type 2 diabetes (74% vs 16%) (all P < 0.01). Patients with NASH had significantly lower HRQL scores related to physical health: Physical Functioning, Bodily Pain, General Health, Vitality, Physical Summary of SF-36, and Fatigue of CLDQ (P < 0.02). By contrast, patients with CHC had a lower Mental Health score of SF-36 and Emotional score of CLDQ and reported greater impairment in daily activities as measured by the Work Productivity and Activity Instrument questionnaire (P < 0.002). In multivariate analysis, after adjustment for demographic parameters, cirrhosis, and history of psychiatric disorders, having NASH was associated with lower physical HRQL scores and higher mental health-related scores (P < 0.05). DISCUSSION: Patients with NASH and advanced fibrosis have more impairment of their physical health-related scores than patients with CHC with advanced fibrosis. These data should dispel the misconception that NASH is an asymptomatic disease with little negative impact on patients' well-being.

Original languageEnglish
Pages (from-to)1636-1641
Number of pages6
JournalThe American journal of gastroenterology
Issue number10
Publication statusPublished - Oct 1 2019

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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