Browsing by Author "Yilmaz, Yusuf"

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    A Global Survey of Physicians Knowledge About Nonalcoholic Fatty Liver Disease
    (2022) Younossi, Zobair M.; Ong, Janus P.; Takahashi, Hirokazu; Yilmaz, Yusuf; Hi, Yuichiro Eguc; El Kassas, Mohamed; Buti, Maria; Diago, Moises; Zheng, Ming-Hua; Fan, Jian-Gao; Yu, Ming-Lung; Wong, Vincent Wai-Sun; Alswat, Khalid; Chan, Wah-Kheong; Mendez-Sanchez, Nahum; Burra, Patrizia; Bugianesi, Elisabetta; Duseja, Ajay K.; George, Jacob; Papatheodoridis, George, V; Saeed, Hamid; Castera, Laurent; Arrese, Marco; Kugelmas, Marcelo; Romero-Gomez, Manuel; Alqahtani, Saleh; Ziayee, Mariam; Lam, Brian; Younossi, Issah; Racila, Andrei; Henry, Linda; Stepanova, Maria
    BACKGROUND & AIMS: Despite rapidly increasing nonalcoholic fatty liver disease (NAFLD) prevalence, providers' knowledge may be limited. We assessed NAFLD knowledge and associated factors among physicians of different specialties globally.
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    A multisociety Delphi consensus statement on new fatty liver disease nomenclature
    (2023) Rinella, Mary E.; Lazarus, Jeffrey V.; Ratziu, Vlad; Francque, Sven M.; Sanyal, Arun J.; Kanwal, Fasiha; Romero, Diana; Abdelmalek, Manal F.; Anstee, Quentin M.; Arab, Juan Pablo; Arrese, Marco; Bataller, Ramon; Beuers, Ulrich; Boursier, Jerome; Bugianesi, Elisabetta; Byrne, Christopher D.; Narro, Graciela E. Castro; Chowdhury, Abhijit; Cortez-Pinto, Helena; Cryer, Donna R.; Cusi, Kenneth; El-Kassas, Mohamed; Klein, Samuel; Eskridge, Wayne; Fan, Jiangao; Gawrieh, Samer; Guy, Cynthia D.; Harrison, Stephen A.; Kim, Seung Up; Koot, Bart G.; Korenjak, Marko; Howdley, Kris V.; Lacaille, Florence; Loomba, Rohit; Mitchell-Thain, Robert; Morgan, Timothy R.; Powell, Elisabeth E.; Roden, Michael; Romero-Gomez, Manuel; Silva, Marcelo; Singh, Shivaram Prasad; Sookbian, Silvia C.; Spearman, C. Wendy; Tiniakos, Dina; Valenti, Luca; Vos, Miriam B.; Wong, Vincent Wai-Sun; Xanthakos, Stavra; Yilmaz, Yusuf; Younossi, Zobair; Hobbs, Ansley; Villota-Rivas, Marcela; Newsome, Philip N.
    The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favour of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. A total of 236 panellists from 56 countries participated in 4 online surveys and 2 hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83%, and 78%, respectively. Seventy-four percent of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms "nonalcoholic" and "fatty" were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease was chosen as an overarching term to encompass the various aetiologies of steatosis. The term steato-hepatitis was felt to be an important pathophysiological concept that should be retained. The name chosen to replace NAFLD was metabolic dysfunction-associated steatotic liver disease (MASLD). There was consensus to change the definition to include the presence of at least 1 of 5 cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic steatotic liver disease. A new category, outside pure metabolic dysfunction-associated steatotic liver disease, termed metabolic and alcohol related/associated liver disease (MetALD), was selected to describe those with metabolic dysfunction-associated steatotic liver disease, who consume greater amounts of alcohol per week (140-350 g/wk and 210-420 g/ wk for females and males, respectively). The new nomenclature and diagnostic criteria are widely supported and non-stigmatising, and can improve awareness and patient identification.(c) 2023 American Association for the Study of Liver Diseases (AASLD), European Association for the Study of the Liver (EASL), and Fundacion Clinica Medica Sur, A.C. Published by Wolters Kluwer/Elsevier B.V/ Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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    A multisociety Delphi consensus statement on new fatty liver disease nomenclature
    (2023) Rinella, Mary E.; Lazarus, Jeffrey V.; Ratziu, Vlad; Francque, Sven M.; Sanyal, Arun J.; Kanwal, Fasiha; Romero, Diana; Abdelmalek, Manal F.; Anstee, Quentin M.; Pablo Arab, Juan; Arrese, Marco; Bataller, Ramon; Beuers, Ulrich; Boursier, Jerome; Bugianesi, Elisabetta; Byrne, Christopher D.; Castro Narro, Graciela E.; Chowdhury, Abhijit; Cortez-Pinto, Helena; Cryer, Donna R.; Cusi, Kenneth; El-Kassas, Mohamed; Klein, Samuel; Eskridge, Wayne; Fan, Jiangao; Gawrieh, Samer; Guy, Cynthia D.; Harrison, Stephen A.; Kim, Seung Up; Koot, Bart G.; Korenjak, Marko; Kowdley, Kris V.; Lacaille, Florence; Loomba, Rohit; Mitchell-Thain, Robert; Morgan, Timothy R.; Powell, Elisabeth E.; Roden, Michael; Romero-Gomez, Manuel; Silva, Marcelo; Singh, Shivaram Prasad; Sookoian, Silvia C.; Spearman, C. Wendy; Tiniakos, Dina; Valenti, Luca; Vos, Miriam B.; Wong, Vincent Wai-Sun; Xanthakos, Stavra; Yilmaz, Yusuf; Younossi, Zobair; Hobbs, Ansley; Villota-Rivas, Marcela; Newsome, Philip N.
    The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favor of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. A total of 236 panelists from 56 countries participated in 4 online surveys and 2 hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83%, and 78%, respectively. Seventy-four percent of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms "nonalcoholic" and "fatty" were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease was chosen as an overarching term to encompass the various aetiologies of steatosis. The term steatohepatitis was felt to be an important pathophysiological concept that should be retained. The name chosen to replace NAFLD was metabolic dysfunction-associated steatotic liver disease. There was consensus to change the definition to include the presence of at least 1 of 5 cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic steatotic liver disease. A new category, outside pure metabolic dysfunction-associated steatotic liver disease, termed metabolic and alcohol related/associated liver disease (MetALD), was selected to describe those with metabolic dysfunction-associated steatotic liver disease, who consume greater amounts of alcohol per week (140-350 g/wk and 210-420 g/wk for females and males, respectively). The new nomenclature and diagnostic criteria are widely supported and nonstigmatising, and can improve awareness and patient identification.
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    Advancing the global public health agenda for NAFLD: a consensus statement
    (2022) Lazarus, Jeffrey, V; Mark, Henry E.; Anstee, Quentin M.; Arab, Juan Pablo; Batterham, Rachel L.; Castera, Laurent; Cortez-Pinto, Helena; Crespo, Javier; Cusi, Kenneth; Dirac, M. Ashworth; Francque, Sven; George, Jacob; Hagstrom, Hannes; Huang, Terry T-K; Ismail, Mona H.; Kautz, Achim; Sarin, Shiv Kumar; Loomba, Rohit; Miller, Veronica; Newsome, Philip N.; Ninburg, Michael; Ocama, Ponsiano; Ratziu, Vlad; Rinella, Mary; Romero, Diana; Romero-Gomez, Manuel; Schattenberg, Jorn M.; Tsochatzis, Emmanuel A.; Valenti, Luca; Wong, Vincent Wai-Sun; Yilmaz, Yusuf; Younossi, Zobair M.; Zelber-Sagi, Shira
    Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics - from epidemiology, awareness, care and treatment to public health policies and leadership - that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD.
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    Effects of Alcohol Consumption and Metabolic Syndrome on Mortality in Patients With Nonalcoholic and Alcohol-Related Fatty Liver Disease
    (2019) Younossi, Zobair M.; Stepanova, Maria; Ong, Janus; Yilmaz, Yusuf; Duseja, Ajay; Eguchi, Yuichiro; El Kassas, Mohamed; Castellanos-Fernandez, Marlen; George, Jacob; Jacobson, Ira M.; Bugianesi, Elisabetta; Wong, Vincent Wai-Sun; Arrese, Marco; de Ledinghen, Victor; Romero-Gomez, Manuel; Mendez-Sanchez, Nahum; Ahmed, Aijaz; Wong, Robert; Papatheodoridis, Georgios; Serfaty, Lawrence; Younossi, Issah; Nader, Fatema; Ziayee, Mariam; Afendy, Arian
    BACKGROUND & AIMS: Non-alcoholic and alcohol-related fatty liver disease are overlapping diseases in which metabolic syndrome and alcohol consumption each contribute to progressive liver disease. We aimed to assess the effects of alcohol consumption and metabolic syndrome on mortality in individuals with fatty liver.
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    Global survey of stigma among physicians and patients with nonalcoholic fatty liver disease
    (2024) Younossi, Zobair M.; Alqahtani, Saleh A.; Alswat, Khalid; Yilmaz, Yusuf; Keklikkiran, Caglayan; Funuyet-Salas, Jesus; Romero-Gomez, Manuel; Fan, Jian-Gao; Zheng, Ming-Hua; El-Kassas, Mohamed; Castera, Laurent; Liu, Chun-Jen; Wong, Vincent Wai-Sun; Zelber-Sagi, Shira; Allen, Alina M.; Lam, Brian; Treeprasertsuk, Sombat; Hameed, Saeed; Takahashi, Hirokazu; Kawaguchi, Takumi; Schattenberg, Joern M.; Duseja, Ajay; Newsome, Phil N.; Francque, Sven; Spearman, C. Wendy; Fernandez, Marlen I. Castellanos; Burra, Patrizia; Roberts, Stuart K.; Chan, Wah-Kheong; Arrese, Marco; Silva, Marcelo; Rinella, Mary; Singal, Ashwani K.; Gordon, Stuart; Fuchs, Michael; Alkhouri, Naim; Cusi, Kenneth; Loomba, Rohit; Ranagan, Jane; Eskridge, Wayne; Kautz, Achim; Ong, Janus P.; Kugelmas, Marcelo; Eguchi, Yuichiro; Diago, Moises; Yu, Ming-Lung; Gerber, Lynn; Fornaresio, Lisa; Nader, Fatema; Henry, Linda; Racila, Andrei; Golabi, Pegah; Stepanova, Maria; Carrieri, Patrizia; Lazarus, Jeffrey, V
    Background & Aims: Patients with fatty liver disease may experience stigma from the disease or comorbidities. In this cross-sectional study, we aimed to understand stigma among patients with nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) and healthcare providers. Methods: Members of the Global NASH Council created two surveys about experiences/attitudes toward NAFLD and related diagnostic terms: a 68-item patient and a 41-item provider survey. Results: Surveys were completed by 1,976 patients with NAFLD across 23 countries (51% Middle East/North Africa [MENA], 19% Europe, 17% USA, 8% Southeast Asia, 5% South Asia) and 825 healthcare providers (67% gastroenterologists/hepatologists) across 25 countries (39% MENA, 28% Southeast Asia, 22% USA, 6% South Asia, 3% Europe). Of all patients, 48% ever disclosed having NAFLD/NASH to family/friends; the most commonly used term was "fatty liver" (88% at least sometimes); "metabolic disease" or "MAFLD" were rarely used (never by >84%). Regarding various perceptions of diagnostic terms by patients, there were no substantial differences between "NAFLD", "fatty liver disease (FLD)", "NASH", or "MAFLD". The most popular response was being neither comfortable nor uncomfortable with either term (56%-71%), with slightly greater discomfort with "FLD" among the US and South Asian patients (47-52% uncomfortable). Although 26% of patients reported stigma related to overweight/obesity, only 8% reported a history of stigmatization or discrimination due to NAFLD. Among providers, 38% believed that the term "fatty" was stigmatizing, while 34% believed that "nonalcoholic" was stigmatizing, more commonly in MENA (43%); 42% providers (gastroenterologists/hepatologists 45% vs. 37% other specialties, p = 0.03) believed that the name change to metabolic dysfunction-associated steatotic liver disease (or MASLD) might reduce stigma. Regarding the new nomenclature, the percentage of providers reporting "steatotic liver disease" as stigmatizing was low (14%). Conclusions: The perception of NAFLD stigma varies among patients, providers, geographic locations and sub-specialties. (c) 2023 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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    Real-world evidence on non-invasive tests and associated cut-offs used to assess fibrosis in routine clinical practice
    (2023) Lazarus, Jeffrey, V; Castera, Laurent; Mark, Henry E.; Allen, Alina M.; Adams, Leon A.; Anstee, Quentin M.; Arrese, Marco; Alqahtani, Saleh A.; Bugianesi, Elisabetta; Colombo, Massimo; Cusi, Kenneth; Hagstrom, Hannes; Loomba, Rohit; Romero-Gomez, Manuel; Schattenberg, Jorn M.; Thiele, Maja; Valenti, Luca; Wong, Vincent Wai-Sun; Yilmaz, Yusuf; Younossi, Zobair M.; Francque, Sven M.; Tsochatzis, Emmanuel A.
    Background & Aims: Non-invasive tests (NITs) offer a practical solution for advanced fibrosis identification in non-alcoholic fatty liver disease (NAFLD). Despite increasing implementation, their use is not standardised, which can lead to inconsistent interpretation and risk stratification. We aimed to assess the types of NITs and the corresponding cut-offs used in a range of healthcare settings. Methods: A survey was distributed to a convenience sample of liver health experts who participated in a global NAFLD consensus statement. Respondents provided information on the NITs used in their clinic with the corresponding cut-offs and those used in established care pathways in their areas.Results: There were 35 respondents from 24 countries, 89% of whom practised in tertiary level settings. A total of 14 different NITs were used, and each respondent reported using at least one (median = 3). Of the respondents, 80% reported using FIB-4 and liver stiffness by vibration-controlled transient elastography (Fibroscan & REG;), followed by the NAFLD fibrosis score (49%). For FIB-4, 71% of respondents used a low cut-off of <1.3 (range <1.0 to <1.45) and 21% reported using age-specific cut-offs. For Fibroscan & REG;, 21% of respondents used a single liver stiffness cut-off: 8 kPa in 50%, while the rest used 7.2 kPa, 7.8 kPa and 8.7 kPa. Among the 63% of respondents who used lower and upper liver stiffness cut-offs, there were variations in both values (<5 to <10 kPa and >7.5 to >20 kPa, respectively).Conclusions: The cut-offs used for the same NITs for NAFLD risk stratification vary between clinicians. As cut-offs impact test performance, these findings underscore the heterogeneity in risk-assessment and support the importance of establishing consistent guidelines on the standardised use of NITs in NAFLD management. Lay summary: Owing to the high prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population it is important to identify those who have more advanced stages of liver fibrosis, so that they can be properly treated. Non-invasive tests (NITs) provide a practical way to assess fibrosis risk in patients. However, we found that the cut-offs used for the same NITs vary between clinicians. As cut-offs impact test performance, these findings highlight the importance of establishing consistent guidelines on the standardised use of NITs to optimise clinical management of NAFLD.& COPY; 2022 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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    The case for simplifying and using absolute targets for viral hepatitis elimination goals
    (2021) Razavi, Homie; Blach, Sarah; Razavi-Shearers, Devin; Abaalkhail, Faisal; Abbas, Zaigham; Abdallah, Ayat; Ferreira, Paulo Abrao; Abu Raddad, Laith Jamal; Adda, Danjuma; Agarwal, Kosh; Aghemo, Alessio; Ahmed, Aijaz; Al-Busafi, Said A.; Al-hamoudi, Waleed; Al-Kaabi, Saad; Al-Romaihi, Hamad; Aljarallah, Badr; AlNaamani, Khalid; Alqahtani, Saleh; Alswat, Khalid; Altraif, Ibrahim; Asselah, Tarik; Bacon, Bruce; Bessone, Fernando; Bizri, Abdul Rahman; Block, Tim; Bonino, Ferruccio; BranclaoMello, Carlos Eduardo; Browny, Kimberly; Bruggmann, Philip; Brunetto, Maurizia Rossana; Buti, Maria; Cabezas, Joaquin; Calleja, Jose Luis; Batanjer, Erika Castro; Chan, Henry Lik-Yuen; Chang, Henry; Chen, Chien-Jen; Christensen, Peer Brehm; Chuang, Wan-Long; Cisneros, Laura; Cohen, Chari; Colombo, Massimo; Conway, Brian; Cooper, Curtis; Craxi, Antonio; Crespo, Javier; Croes, Esther; Cryer, Donna; de Barros, Fernando Passos Cupertino; Derbala, Moutaz; Dillon, John; Doss, Wahid; Dou, Xiaoguang; Doyle, Joseph; Duberg, Ann-Sofi; Dugan, Ellen; Dunn, Rick; Dusheiko, Geoffrey; El Khayat, Hisham; EI-Sayed, Manal H.; Eshraghian, Ahad; Esmat, Gamal; Mur, Rafael Esteban; Ezzat, Sameera; Falconer, Karolin; Fassio, Eduardo; Ferrinho, Paulo; Flamm, Steven; Flisiak, Robert; Foster, Graham; Fung, James; Garcia-Samaniego, Javier; Gish, Robert G.; Goncales, Fernando; Halota, Waldemar; Hamoudi, Waseem; Hassany, Mohamed; Hatzakis, Angelos; Hay, Susan; Himatt, Sayed; Hoepelman, I. M.; Hsu, Yao-Chun; Hui, Yee Tak; Hunyady, Bela; Jacobson, Ira; Janjua, Naveed; Janssen, Harry; Jarcuska, Peter; Kabagambe, Kenneth; Kanto, Tatsuya; Kao, Jia-Horng; Kaymakoglu, Sabahattin; Kershenobich, David; Khamis, Faryal; Kim, Dong Joon; Kim, Young; Kondili, Loreta A.; KottiliI, Shyamasundaran; Kramvis, Anna; Kugelmas, Marcelo; Kurosaki, Masayuki; Lacombe, Karine; Lagging, Martin; Lao, WaiCheung; Lavanchy, Daniel; Lazarus, Jeffrey, V; Lee, Alice; Lee, Samual S.; Levyl, Miriam; Liakina, Valentina; Lim, YoungSuk; Liu, Shuang; Maddrey, Willis; Malekzade, Reza; Marinho, Rui Tato; Mathur, Poonam; Maticic, Mojca; Mendes Correa, Maria Cassia; Mera, Jorge; Merat, Shahin; Mogawer, Sherif; Mohamed, Rosmawati; Muellhaupti, Beat; Muljono, David; Mostafa, Ibrahim; Nahum, Mendez Sanchez; Nawaz, Arif; Negro, Francesco; Ninburg, Michael; Ning, Qing; Ntiri-Reid, Boatemaa; Nymadawa, Pagbajabyn; Oevrehus, Anne; Ormeci, Necati; Orrego, Mauricio; Osman, Alaa; Oyunsuren, Tsendsuren; Pant, Calvin; Papaevangelou, Vassiliki; Papatheodoridis, George; Popping, Stephanie; Prasad, Papu; Prithiviputh, Rittoo; Qureshi, Huma; Ramji, Alnoor; Razavi-Shearer, Kathryn; Reddy, Rajender; Remak, William; Richter, Clemens; Ridruejo, Ezequiel; Robaeys, Geert; Robert, Stuart; Roberts, Lewis; Roudot-Thoraval, Francoise; Saab, Sammy; Said, Sanaa; Salamat, Amjad; Sanai, Faisal; Sanchez-Avila, Juan Francisco; Schiff, Eugene; Schinazi, Raymond; Sebastiani, Giada; Seguin-Devaux, Carole; Shanmugam, R. P.; Sharara, Ala; Shilton, Sonjelle; Shouval, Daniel; Sievert, William; Simonova, Marieta; Sohrabpour, Amir Ali; Sonderup, Mark; Soza, Alejandro; Spearman, C. Wendy; Steinfurth, Nancy; Sulkowski, Mark; Tan, Soek-Siam; Tanaka, Junko; Tashi, Dhondup; Thein, Hla-Hla; Thompson, Peyton; Tolmane, Ieva; Toy, Mehlika; Valantinas, Jonas; Van de Vijver, David; Velez-Moller, Patricia; Vince, Adriana; Waked, Imam; Wang, Su; Wedemeyer, Heiner; Wong, Vincent; Xie, Qing; Yamada, Seiji; Yang, Hwai-, I; Yesmembetov, Kakharman; Yilmaz, Yusuf; Younossi, Zobair; Yu, Ming-Lung; Yuen, Man-Fung; Yurdaydin, Cihan; Yusuf, Aasim; Zekry, Amany; Zeuzem, Stefan
    The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries' progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to <= 5 per 100 000, reduce HBV prevalence among 1-year-olds to <= 0.1%, reduce HBV and HCV mortality to <= 5 per 100 000, and demonstrate HBV and HCV year-to-year decrease in new HCV- and HBV-related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit.
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    The impact of stigma on quality of life and liver disease burden among patients with nonalcoholic fatty liver disease
    (2024) Younossi, Zobair M.; AlQahtani, Saleh A.; Funuyet-Salas, Jesus; Romero-Gomez, Manuel; Yilmaz, Yusuf; Keklikkiran, Caglayan; Alswat, Khalid; Yu, Ming-Lung; Liu, Chun-Jen; Fan, Jian-Gao; Zheng, Ming-Hua; Burra, Patrizia; Francque, Sven M.; Castera, Laurent; Schattenberg, Joern M.; Newsome, Philip N.; Allen, Alina M.; El-Kassas, Mohamed; Treeprasertsuk, Sombat; Hameed, Saeed; Wong, Vincent Wai-Sun; Zelber-Sagi, Shira; Takahashi, Hirokazu; Kawaguchi, Takumi; Fernandez, Marlen I. Castellanos; Duseja, Ajay; Arrese, Marco; Rinella, Mary; Singal, Ashwani K.; Gordon, Stuart C.; Fuchs, Michael; Eskridge, Wayne; Alkhouri, Naim; Cusi, Kenneth; Loomba, Rohit; Ranagan, Jane; Kautz, Achim; Ong, Janus P.; Kugelmas, Marcelo; Eguchi, Yuichiro; Diago, Moises; Gerber, Lynn; Lam, Brian; Fornaresio, Lisa; Nader, Fatema; Spearman, C. Wendy; Roberts, Stuart K.; Chan, Wah-Kheong; Silva, Marcelo; Racila, Andrei; Golabi, Pegah; Ananchuensook, Prooksa; Henry, Linda; Stepanova, Maria; Carrieri, Patrizia; Lazarus, Jeffrey, V
    Background & Aims: Patients with nonalcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) face a multifaceted disease burden which includes impaired health-related quality of life (HRQL) and potential stigmatization. We aimed to assess the burden of liver disease in patients with NAFLD and the relationship between experience of stigma and HRQL. Methods: Members of the Global NASH Council created a survey about disease burden in NAFLD. Participants completed a 35-item questionnaire to assess liver disease burden (LDB) (seven domains), the 36-item CLDQ-NASH (six domains) survey to assess HRQL and reported their experience with stigmatization and discrimination. Results: A total of 2,117 patients with NAFLD from 24 countries completed the LDB survey (48% Middle East and North Africa, 18% Europe, 16% USA, 18% Asia) and 778 competed CLDQ-NASH. Of the study group, 9% reported stigma due to NAFLD and 26% due to obesity. Participants who reported stigmatization due to NAFLD had substantially lower CLDQ-NASH scores (all p <0.0001). In multivariate analyses, experience with stigmatization or discrimination due to NAFLD was the strongest independent predictor of lower HRQL scores (beta from -5% to -8% of score range size, p <0.02). Experience with stigmatization due to obesity was associated with lower Activity, Emotional Health, Fatigue, and Worry domain scores, and being uncomfortable with the term "fatty liver disease" with lower Emotional Health scores (all p <0.05). In addition to stigma, the greatest disease burden as assessed by LDB was related to patients' self-blame for their liver disease. Conclusions: Stigmatization of patients with NAFLD, whether it is caused by obesity or NAFLD, is strongly and independently associated with a substantial impairment of their HRQL. Self-blame is an important part of disease burden among patients with NAFLD. Impact and implications: Patients with nonalcoholic fatty liver disease (NAFLD), recently renamed metabolic dysfunction-associated steatotic liver disease (MASLD), may experience impaired health-related quality of life and stigmatization. Using a specifically designed survey, we found that stigmatization of patients with NAFLD, whether it is caused by obesity or the liver disease per se, is strongly and independently associated with a substantial impairment of their quality of life. Physicians treating patients with NAFLD should be aware of the profound implications of stigma, the high prevalence of self-blame in the context of this disease burden, and that providers' perception may not adequately reflect patients' perspective and experience with the disease. (c) 2024 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).