PLoS ONE (Jan 2022)

Stigmatization is common in patients with non-alcoholic fatty liver disease and correlates with quality of life.

  • Marta Carol,
  • Martina Pérez-Guasch,
  • Elsa Solà,
  • Marta Cervera,
  • Sara Martínez,
  • Adrià Juanola,
  • Ann T Ma,
  • Emma Avitabile,
  • Laura Napoleone,
  • Elisa Pose,
  • Isabel Graupera,
  • Maria Honrubia,
  • Marko Korenjak,
  • Ferran Torres,
  • Pere Ginès,
  • Núria Fabrellas,
  • LiverHope Consortium Investigators

DOI
https://doi.org/10.1371/journal.pone.0265153
Journal volume & issue
Vol. 17, no. 4
p. e0265153

Abstract

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Background and aimsStigmatization is a well-documented problem of some diseases. Perceived stigma is common in alcohol-related liver disease and hepatitis C, but little information exists on stigma in patients with non-alcoholic fatty liver disease (NAFLD). Aim of the study was to investigate frequency and characteristics of perceived stigma among patients with NAFLD.MethodsOne-hundred and ninety-seven patients seen at the liver clinic were included: a study group of 144 patients with NAFLD, 50 with cirrhosis (34 compensated, 16 decompensated), and a control group of 53 patients with alcohol-related cirrhosis. Demographic, clinical, and laboratory data were collected. Quality-of-life was assessed by chronic liver disease questionnaire (CLDQ). Perceived stigma was assessed using a specific questionnaire for patients with liver diseases categorized in 4 domains: stereotypes, discrimination, shame, and social isolation.ResultsPerceived stigma was common in patients with NAFLD (99 patients, 69%) and affected all 4 domains assessed. The frequency was slightly higher, yet not significant, in patients with NAFLD cirrhosis vs those without (72% vs 67%, respectively; p = 0.576). In patients without cirrhosis perceived stigma was unrelated to stage of disease, since frequency was similar in patients with no or mild fibrosis compared to those with moderate/severe fibrosis (66% vs 68%, respectively). There were no differences in perceived stigma between patients with compensated cirrhosis and these with decompensated cirrhosis. Among patients with cirrhosis, stigmatization was more common in alcohol-related vs NAFLD-cirrhosis, yet differences were only significant in two domains. In patients with NAFLD, perceived stigma correlated with poor quality-of-life, but not with demographic or clinical variables.ConclusionsPerceived stigmatization is common among patients with NAFLD independently of disease stage, is associated with impaired quality-of-life, and may be responsible for stereotypes, discrimination, shame, and social isolation, which may affect human and social rights of affected patients.