Ministerio de Ciencia e Innovación

Seven out of every ten patients with non-alcoholic fatty liver disease feel stigmatized

Núria Fabrellas and Marta Carol, last and first author, respectively, of the study.
IDIBAPS/CLINIC/CIBER | jueves, 12 de mayo de 2022

Nearly seven out of every ten patients (69%) that suffer from non-alcoholic fatty liver disease (NAFLD) perceive some type of stigmatization in their everyday life. This is the conclusion of a study led by researchers from the Hospital Clínic-IDIBAPS, from the University of Barcelona, and from CIBEREHD, the CIBER (Networking Biomedical Research Centre) for Liver and Digestive Diseases, which has been published by the journal Plos One. According to this research, the stigma perceived by these patients is also associated with a deterioration in quality of life that is common among people with NAFLD.

Stigma in hepatic diseases

Stigmatization is a well-documented problem in some diseases. Liver diseases are considered stigmatized diseases, possibly due to their association with alcoholism and drug abuse. In fact, studies have shown that patients with infection due to hepatitis C and B are frequently stigmatized independently of the method of virus transmission and patients with cirrhosis are frequently stigmatized independently of the cause of their disease. However, little information exists on stigma among patients with non-alcoholic fatty liver disease. For this reason, the aim of the study was to investigate the frequency and characteristics of the perceived stigma among patients with NAFLD.

Non-alcoholic fatty liver disease is the most common hepatic disease worldwide, affecting approximately 24% of the world population, and it is frequently associated with obesity and metabolic syndrome. NAFLD is a progressive disease, and a significant proportion of patients evolve from simple steatosis to cirrhosis or hepatocellular carcinoma. “It is possible that NAFLD is a stigmatized disease because it affects the liver and is frequently associated with obesity, two conditions that are frequent causes of stigma”, points out Marta Carol, pre-doctoral researcher from the IDIBAPS group Chronic liver diseases: molecular mechanisms and clinical consequences, led by Pere Ginès, and one of the main authors of this study.

To study the stigma perceived by people with NAFLD, the study collected data from 197 patients attending at the Liver Unit of the Hospital Clínic in Barcelona. Of these, 144 had NAFLD and 53 were suffering from cirrhosis related to alcohol consumption, in order to compare both groups. Given that NAFLD is frequently associated with a deterioration in quality of life, the relationship was also explored between the perceived stigma and quality of life in these patients. The perceived stigma was evaluated through a specific questionnaire, categorised into 4 domains: stereotypes, discrimination, embarrassment and social isolation.

Stereotypes, discrimination, embarrassment, and social isolation

The results obtained indicated that 69% of patients with NAFLD feel stigmatised and that that perceived stigma affects the 4 domains evaluated. Among these patients with NAFLD, those in which the disease had evolved to cirrhosis had a greater feeling of stigma (72%) than patients without cirrhosis (67%). And among the patients with cirrhosis, the stigmatization was more common in cirrhosis related with alcohol than in NAFLD, although the differences were only significant in two domains. Also, in patients with NAFLD, the stigma perceived correlated with a poor quality of life.

“Stigmatization is considered a very relevant issue in some illnesses due to its potential negative impact on the state of health of patients and the fact that it reduces the possibility of these people accessing care and recovery”, explains Pere Ginès, head of the IDIBAPS group Chronic liver diseases: molecular mechanisms and clinical consequences and one of the coordinators of the research. “In fact, in recent years, there has been a growing interest fighting against the stigmatization of certain diseases with the aim of improving the social acceptance of patients and their general state of health” he added.

“Perceived stigmatization is common among patients with NAFLD, independently of the stage of the disease. It is associated with a deterioration in quality of life and may be responsible for stereotypes, discrimination, embarrassment and social isolation, which can affect the human and social rights of the patients affected,” alerts this team of researchers.

For this reason, “the results of this study represent a warning signal regarding the importance of this feeling of stigmatization in patients with NAFLD, which modifies very sensitive areas of life,” they point out. “We believe that these findings should be taken into account by health workers, patient associations and those responsible for healthcare and social work policies, with a view to stimulating further research and encouraging initiatives designed to prevent discrimination against people affected by this disease,” they conclude.

Reference article

Carol M, Pérez-Guasch M, Solà E, Cervera M, Martínez S, Juanola A, Ma AT, Avitabile E, Napoleone L, Pose E, Graupera I, Honrubia M, Korenjak M, Torres F, Ginès P, Fabrellas N; LiverHope Consortium Investigators. Stigmatization is common in patients with non-alcoholic fatty liver disease and correlates with quality of life. PLoS One. 2022 Apr 6;17(4):e0265153. doi: 10.1371/journal.pone.0265153. PMID: 35385510; PMCID: PMC8986095