Exploring the association between quality of life, diet, physical activity, and binge eating disorder in nafld patients in a tertiary centre of care

Background

Non-alcoholic fatty liver disease (NAFLD) is a rapidly growing cause of chronic liver disease, whose main treatment centres around lifestyle modifications and weight loss. However, weight loss remains challenging, with specific barriers to achieve this being only partially explored. Moreover, increasing evidence suggests a higher prevalence of psychiatric comorbidities, including eating disorders, in NAFLD patients, making lifestyle changes even more challenging to achieve. In this study, we aimed to explore the association between quality of life, quality of diet, physical activity, and eating disorder in NAFLD patients.

Methods

Consecutive patients with a clinical or histological diagnosis of NAFLD, followed up in the specialist liver clinic at St Mary’s Hospital, Imperial College Healthcare Trust, between October 2022 and April 2023 were included. During consulation, four questionnaires were administered: the 36-Item Short Form survey (SF36) for quality of life, Mediterranean Diet Score (MDS) for diet quality, International Physical Activity Questionnaire (IPAQ) for physical activity, and the 7-item Binge-Eating Disorder Screener (BEDS-7) to screen for eating disorder. Quality of life was analysed using the RAND Corporation Medical Outcomes study as reference. Patients demographic and clinical parametric data, and non-invasive markers of fibrosis were collected at the time of the visit.

Results

Overall, 102 patients were enrolled. Compared to the RAND Corporation Medical Outcomes Study, NAFLD patients showed lower scores in all five of the quality-of-life domains (p<0.05): physical functioning, emotional well-being, social functioning, pain, and general health. Moreover, those at risk of BED were significantly younger (44 vs 61 years, p<0.001). Of note, a greater adherence to the Mediterranean diet, as per MDS, was associated with better scores in emotional well-being (84.7 vs 51, p=0.024) and in energy/emotions (64.2 vs 41.6, p=0.01). Similarly, those who remained physical active, as per IPAQ, showed better performance in physical functioning (92 vs 50, p=0.006), emotional wellbeing (92 vs 54, p=0.029), energy/emotions (73 vs 45, p=0.002) and general health (61 vs 43, p=0.02). On multivariate analysis, physical activity was independently associated with a better score in ‘role limitations due to emotional problems’ SF36 domain (OR:1.058, 95%CI [1.003–1.116], p=0.037) and a lower CAP score (OR:0.954, 95%CI [0.911–1.000], p=0.049).

Conclusions

A higher adherence to Mediterranean diet and to physical activity translated into better performance quality of life. In NAFLD patients, lifestyle modifications should be encouraged not only for the clinical benefits, but also for their potential benefit on overall wellbeing. A holistic approach should include a multidimensional management of these patients.