Fatigue and non-alcoholic fatty liver disease: Data from the global nash registry

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Conference Proceeding

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Background: Fatigue is a major driver of impairment in health-related quality of life (HRQL) and other patient-reported outcomes (PROs). NAFLD is associated with high prevalence of fatigue which worsens with comorbidities and severity of liver disease. We assessed changes in fatigue over time among patients from the Global NAFLD/NASH Registry™. Methods: Clinical and PRO (FACIT-F, CLDQ-NASH, WPAI) data were collected at baseline and one-year follow-up. Significant fatigue was defined as Fatigue Scale of FACIT-F<30 (range 0-52, lower score indicates more fatigue). Significant changes in fatigue (improvement/worsening) were defined as a ±3-point change in Fatigue Scale from a patient's own baseline score. Results: NAFLD patients with baseline and follow-up clinical and PRO data, including FACIT-F (n=918) were included in this analysis: age 52±11 years old, 52% male, 44% employed, 64% obese, 52% type 2 diabetes, 46% hypertension, 21% cirrhosis, 18% history of depression, 17% sleep apnea, 21% abdominal pain, and 26% with baseline clinically significant fatigue. At 1-year follow-up, 49% of NAFLD experienced fatigue improvement, 30% had their fatigue score unchanged, and 21% experienced worsening of fatigue scores. Patients who experienced fatigue improvement were younger (mean age 51 years vs. 52 years in patients whose fatigue score unchanged vs. 54 years in fatigue worsened), experienced a greater BMI decrease (mean -1.9 vs. -0.6 vs. -0.7 kg/m2, respectively), and had significant fatigue at baseline (42% vs. 10% vs. 12%, respectively) (all p<0.03). Improvement of fatigue was associated with concurrent improvements in other PRO scores including all domains of CLDQ-NASH (mean ±SE for the total score [range 1-7] +0.88±0.04 vs. +0.18±0.04 vs. -0.20±0.05, respectively), all domains of FACIT-F (total FACIT-F [range 0-160] +23.7±0-9 vs. +2.4±0.8 vs. -13.4±1.1, respectively) as well as Work Productivity (-0.09±0.02 vs. 0.01±0.02 vs. +0.04±0.03) and Activity domains of WPAI (all p<0.01). In multivariate analysis, worsening of fatigue was independently associated with history of depression (odds ratio (OR) = 2.2 (1.1-4.3)), hypertension (OR = 1.7 (1.1-2.8)), and a greater change in BMI (OR = +1.13 (1.02-1.24) per +1 kg/m2). Conclusion: In patients with NAFLD, decrease in BMI is associated with better fatigue scores while an increase in BMI is predictive of worsening fatigue. Changes in fatigue scores highly correlate with changes in HRQL and work productivity scores.

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