Quality of life in children with nonalcoholic fatty liver disease

Abstract

Background. Nonalcoholic fatty liver disease (NAFLD) in recent years is the main cause of chronic liver disease in the pediatric population. Despite the generally asymptomatic course of NAFLD in children, there is a significant frequency of psycho-emotional disorders, impaired social adaptation, low to­lerance to physical activity among these patients, which leads to a deterioration in the quality of life. The purpose of the study was to analyze the changes in the quality of life in children with NAFLD depending on the stage of the disease (simple steatosis, nonalcoholic steatohepatitis (NASH)) according to the SF-36 questionnaire and to determine the impact of clinical manifestations on the quality of life. Materials and methods. The study included 170 patients aged 6 to 17 years, the mean age was (12.15 ± 2.51) years. The fatty liver was determined on transient elastography (FibroScan® 502 Touch F6015, Echosens, France) with the controlled attenuation parameter (CAP) measurement. Patients were divided into 4 groups according to the presence of hepatic stea­tosis (as determined by CAP), overweight and obesity (by body mass index), nonalcoholic steatohepatitis (by gender-specific alanine aminotransferase levels): group 1 consisted of 53 patients with simple hepatic steatosis, group 2 included 37 patients with nonalcoholic steatohepatitis, group 3 enrolled 65 overweight and obese patients without hepatic steatosis, group 4 (control) consisted of 15 patients with normal weight. Quality of life assessment was performed using the Medical Outcomes Study — Short Form-36 questionnaire. The calculation was based on 8 scales, 1–4 of which reflect the physical component of health, and 5–8 scales — the mental component of health. The total score of each scale ranged from 0 to 100 points, with fewer points corresponding to a poorer quality of life. Physical component summary and mental component summary were calculated. Statistical processing of research results was carried out by variation statistics methods, implemented by the standard application package SPSS 13.0 for Windows. Results. Regardless of the stage of the disease, children with NAFLD demonstrated a significant reduction in the total levels of both mental and physical components of health. Analysis of the physical component of health on separate scales showed that children with simple steatosis had the lowest level on the scale of general health (p 0.05). The pain intensity had a small effect on the general characteristics of the physical component of the health in children with NAFLD and differed significantly from the control group only in patients with NASH (p < 0.05). The analysis of the mental component of health showed that in children with NAFLD the vital acti­vity was limited and mental health values decreased significantly compared to children with normal weight (p < 0.05). The most common symptoms that impaired the quality of life of the exami­ned children with NAFLD were fatigue, sleep disturbances, and sadness. NAFLD progression was accompanied by a worsening of both physical and mental component summary levels. The leading cause of significant deterioration in the mental health component in children with NASH was role-emotional dysfunction such as psycho-emotional dysadaptation, which manifested itself in the range of interests restriction, limited participation in everyday activities, impaired ability to concentrate in various activities: this rate showed significantly lower levels compared to children with simple hepatic steatosis (p < 0.05).The quality of life of children with NAFLD negatively correlated with the presence of intestinal disorders on the scales of social and physical functioning, the pain intensity caused by comorbid pathology of the biliary tract, intestine, pancreas. Conclusions. Thus, a study of the quality of life in children with NAFLD using the MOS SF-36 questionnaire showed that the disease negatively affects both physical and mental components of health already at the stage of simple steatosis, the quality of life deteriorates in patients with NASH due to increasing instability of psycho-emotional sphere. With NAFLD progression, there is an increase in the frequency of clinical symptoms, probably associated with comorbidity, which has a negative impact on the quality of life and requires timely correction.

Keywords

• quality of life
• nonalcoholic fatty liver disease
• children