Perceived stigmatization is common among patients with NAFLD, study finds

About seven in ten patients (69%) who suffer from non-alcoholic fatty liver disease (NAFLD) perceive some stigma in their daily lives, according to a study by a team from the University of Barcelona, ​​the Liver and Digestive Diseases Networking Center of Biomedical Research (CIBEREHD), the Hospital Clínic de Barcelona and the August Pi i Sunyer Biomedical Research Institute (IDIBAPS). According to the study published in the journal PLOS ONEthe stigma these patients perceive is also associated with the impaired quality of life that is common in people with NAFLD.

Stigma in liver disease

Liver disease is considered stigmatized—a well-documented problem in certain pathologies—probably because it is associated with alcoholism and drug addiction. Some studies have shown that patients with hepatitis C and B are often stigmatized regardless of the mode of transmission of the virus, while patients with cirrhosis of the liver are also stigmatized regardless of the etiology of the disease. However, there is little information about stigma in patients with non-alcoholic fatty liver disease. Therefore, the study aimed to find the frequency and characteristics of perceived stigma in patients with NAFLD.

Non-alcoholic fatty liver disease is the most common liver disease in the world — it affects almost 24% of the world’s population — and it is often associated with obesity and metabolic syndrome. A significant proportion of patients affected by this progressive disease progress from simple steatosis to cirrhosis or hepatocellular carcinoma.

NAFLD may be a stigmatized disease because it affects the liver and is commonly linked to obesity, two conditions that are common stigma factors. “

Marta Carol, Researcher, UB-CIBEREHD-CLINIC-IDIBAPS and one of the lead authors of the study

As part of the study, the team collected data from 197 patients from the hepatology department of Hospital Clínic de Barcelona, ​​114 of whom had NAFLD and 53 had liver-related cirrhosis. ‘alcohol. Since NAFLD is typically associated with impaired quality of life, they also explored the potential relationship between perceived stigma and quality of life in these patients. Perceived stigma was assessed through a specific questionnaire listed in four areas: stereotypes, discrimination, shame and social isolation.

Stereotypes, discrimination, shame and social isolation

The 69% of NAFLD patients feel stigmatized, a condition that affects all four areas analyzed, according to the findings. Among patients with NAFLD, the feeling of stigma was higher in patients whose disease had progressed to cirrhosis (72%) compared to patients without cirrhosis (67%).

Among patients with cirrhosis, stigma was more common in alcohol-related cirrhosis than in NAFLD, although the differences were significant in two domains. Additionally, in patients with NAFLD, perceived stigma correlated with poor quality of life.

“Stigma is a relevant issue in many diseases because of its potential negative impact on the mental state of patients, in addition to reducing the possibility for these people to access recovery and care”, notes Pere Ginès, professor at the Faculty of Medicine and Health. Sciences, member of CIBEREHD, Clinique Hospitalière and IDIBAPS, and one of the research coordinators. “In recent years, there has been a growing interest in combating the stigmatization of certain diseases to improve the social acceptance of patients and the general state of health”, notes Ginès.

“Perceived stigma – specifies the research team – is frequent in patients with NAFLD regardless of the stage of their disease, it is associated with an impaired quality of life and can be the source of stereotypes, discrimination , shame and social isolation, which can affect the human and social rights of patients”.

Therefore, “the results of this study represent a wake-up call about the importance of this perceived stigma in patients with NAFLD, which has consequences in sensitive areas of life. We believe that healthcare professionals , patient associations and policymakers should take these findings into account to promote research and encourage initiatives to prevent discrimination of people affected by this disease,” the authors conclude.


Journal reference:

Carol, M. et al. (2022) Stigma is common in patients with nonalcoholic fatty liver disease and correlates with quality of life. PLOS A.

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