Metabolic Syndrome Is Associated with Health-Related Quality of Life in Suspected Patients with Nonalcoholic Steatohepatitis

Association of metabolic syndrome components and NAFLD with quality of life: Insights from a cross-sectional study

AIM

Metabolic syndrome (MetS) is associated with higher cardiovascular and metabolic risks, as well as with psychosocial disorders. Data regarding quality of life (QoL) in patients with MetS, point towards a significative association between MetS and a worse QoL. It remains unclear whether MetS components and non-alcoholic fatty liver disease (NAFLD) are associated with QoL in these individuals. We aimed to evaluate the association between QoL of patients with MetS and prespecified metabolic parameters (anthropometric, lipidic and glucose profiles), the risk of hepatic steatosis and fibrosis, and hepatic elastography parameters.

METHODS

Cross-sectional study including patients from microDHNA cohort. This cohort includes patients diagnosed with MetS, 18 to 75 years old, followed in our tertiary center. The evaluation included anamnesis, physical examination, a QoL questionnaire (Short-Form Health Survey, SF-36), blood sampling and hepatic elastography. We used ordered logistic regression models adjusted to sex, age and body mass index to evaluate the associations between the QoL domains evaluated by SF-36 and the prespecified parameters.

RESULTS

We included a total of 65 participants with MetS, with 54% being female and the mean age 61.9 ± 9.6 years old. A worse metabolic profile, specifically higher waist circumference, lower HDL, higher triglycerides, and more severe hepatic steatosis, were associated with worse QoL scores in several domains. We found no significant association of hepatic fibrosis with QoL.

CONCLUSION

Our data suggests that there is a link between a worse metabolic profile (specifically poorer lipidic profile and presence of hepatic steatosis) and a worse QoL in patients with MetS.

The burden of non-alcoholic steatohepatitis: A systematic review of health-related quality of life and patient-reported outcomes

BACKGROUND & AIMS

Non-alcoholic steatohepatitis (NASH) is associated with increased mortality and a high clinical burden. NASH adversely impacts patients' health-related quality of life (HRQoL), but published data on the humanistic burden of disease are limited. This review aimed to summarise and critically evaluate studies reporting HRQoL or patient-reported outcomes (PROs) in populations with NASH and identify key gaps for further research.

METHODS

Medline, EMBASE, the Cochrane Library and PsycINFO were searched for English-language publications published from 2010 to 2021 that reported HRQoL/PRO outcomes of a population or subpopulation with NASH.

RESULTS

Twenty-five publications covering 23 unique studies were identified. Overall, the data showed a substantial impact of NASH on HRQoL, particularly in terms of physical functioning and fatigue, with deterioration of physical and mental health as NASH progresses. Prevalent symptoms, including fatigue, abdominal pain, anxiety/depression, cognition problems, and poor sleep quality, adversely impact patients' ability to work and perform activities of daily living and the quality of relationships. However, some patients fail to attribute symptoms to their disease because of a lack of patient awareness and education. NASH is associated with high rates of comorbidities such as obesity and type 2 diabetes, which contribute to reduced HRQoL. Studies were heterogeneous in terms of diagnostic methods, population, outcomes, follow-up time, and measures of HRQoL/utility. Most studies were rated 'moderate' at quality assessment, and all evaluable studies had inadequate control of confounders.

CONCLUSIONS

NASH is associated with a significant HRQoL burden that begins early in the disease course and increases with disease progression. More robust studies are needed to better understand the humanistic burden of NASH, with adequate adjustment for confounders that could influence outcomes.

LAY SUMMARY

Non-alcoholic steatohepatitis (NASH) has a significant impact on quality of life, with individuals experiencing worse physical and mental health compared with the general population. NASH and its symptoms, which include tiredness, stomach pain, anxiety, depression, poor focus and memory, and impaired sleep, affect individuals' relationships and ability to work and perform day-to-day tasks. However, not all patients are aware that their symptoms may be related to NASH. Patients would benefit from more education on their disease, and the importance of good social networks for patient health and well-being should be reinforced. More studies are needed to better understand the patient burden of NASH.

Validation of a Quantification Method for Curcumin Derivatives and Their Hepatoprotective Effects on Nonalcoholic Fatty Liver Disease

Curcumin (CM), demethoxycurcumin (DMC), and bisdemethoxycurcumin (BDMC) are major curcumin derivatives found in the rhizome of turmeric (Curcuma longa L.), and have yielded impressive properties to halt various diseases. In the present study, we carried out a method validation for curcumin derivatives and analyzed the contents simultaneously using HPLC with UV detection. For validation, HPLC was used to estimate linearity, range, specificity, accuracy, precision, limit of detection (LOD), and limit of quantification (LOQ). Results showed a high linearity of the calibration curve, with a coefficient of correlation (R²) for CM, DMC, and BDMC of 0.9999, 0.9999, and 0.9997, respectively. The LOD values for CM, DMC, and BDMC were 1.16, 1.03, and 2.53 ng/μL and LOQ values were 3.50, 3.11, and 7.67 ng/μL, respectively. Moreover, to evaluate the ability of curcumin derivatives to reduce liver lipogenesis and compare curcumin derivatives’ therapeutic effects, a HepG2 cell model was established to analyze their hepatoprotective properties. Regarding the in vivo study, we investigated the effect of DMC, CM, and BDMC on nonalcoholic fatty liver disease (NAFLD) caused by a methionine choline deficient (MCD)-diet in the C57BL/6J mice model. From the in vitro and in vivo results, curcumin derivatives alleviated MCD-diet-induced lipid accumulation as well as high triglyceride (TG) and total cholesterol (TC) levels, and the protein and gene expression of the transcription factors related to liver adipogenesis were suppressed. Furthermore, in MCD-diet mice, curcumin derivatives suppressed the upregulation of toll-like receptors (TLRs) and the production of pro-inflammatory cytokines. In conclusion, our findings indicated that all of the three curcuminoids exerted a hepatoprotective effect in the HepG2 cell model and the MCD-diet-induced NAFLD model, suggesting a potential for curcuminoids derived from turmeric as novel therapeutic agents for NAFLD.

Active Physical Activity Patterns Are Associated With Improved Quality of Life and Depression Status in Taiwanese Women With Metabolic Syndrome

BACKGROUND

Metabolic syndrome (MetS), health-related quality of life (HRQL), and depression status are independently associated with cardiac health. Therefore, understanding the associations between MetS, HRQL, and depression status and determining factors related to improved HRQL and depression status in people with MetS may help in cardiovascular disease prevention.

OBJECTIVE

The aim of this study was to examine whether there are differences in HRQL and depression status between Taiwanese women with and without MetS and whether physical activity patterns are associated with HRQL and depression status in this population.

METHODS

A cross-sectional study of 326 Taiwanese middle-aged and older women (≥40 years) was conducted. Metabolic syndrome was determined based on the National Cholesterol Education Program Adult Treatment Panel III definition. Health-related quality of life and depression status were collected using the Short Form 36 Health Survey and Beck Depression Inventory. Univariate and multivariate linear regression analyses were conducted.

RESULTS

Women with MetS had lower HRQL (P < .001) and higher depression status (P = .002) than those without MetS. Participants with active physical activity patterns had higher HRQL (P < .001) and lower depression status (P = .046) than those with sedentary patterns. Among women with MetS, those with active physical activity patterns had higher HRQL (P = .001) and lower depression status (P = .007) than those with sedentary patterns.

CONCLUSIONS

Metabolic syndrome is related to lower HRQL and higher depression status in women 40 years and older. Active physical activity patterns are associated with better HRQL and reduced depression status in middle-aged and older women (≥40 years) with MetS.

Prediction of the development of metabolic syndrome by the Markov model based on a longitudinal study in Dalian City

Background

Metabolic syndrome (MetS) increases the incidence of cardiovascular disease and diabetes mellitus. It is essential to study the natural progression of MetS in the interest of prevention. Information on the dynamic changes in MetS in developing countries is limited. This study aimed to simulate the progression of each component of MetS and explore the potential role of these components in early prevention and intervention.

Methods

This study involved 5881 individuals, aged 20 to 60 at study entry, who underwent at least two consecutive years of health check-ups in the seven-year study period at our institution’s health check-up center. Participants were divided into four groups by age (a 20- to- 40-year-old group and a 40- to 60-year-old group) and gender. A Markov model containing 7 stages (no components, isolated hypertension, isolated obesity, isolated hyperglycemia, isolated dyslipidemia, a 2-component state, and the MetS state) was constructed for each group.

Results

In women and young men (20- to 40-year-old men), dyslipidemia and obesity were the two most probable states for individuals who were transitioning from no components to one of the other six states. Among those who had no components and were 30 years old at study entry, MetS was estimated to develop within 10 years in 11.42% of men and 3.04% of women. Among those who had no components and were 50 years old at study entry, MetS was estimated to develop within 10 years in 25.04% of men and 7.09% of women. The estimated prevalence of MetS over the next 10 years was higher in individuals starting with the obesity component than in individuals starting with any other isolated component. In a comparison of interventions targeting single components, simulations showed that the obesity intervention produced the largest relative reduction in the prevalence of MetS.

Conclusion

Markov models are suitable for describing and predicting the dynamic development of MetS. The occurrence of MetS most frequently began with dyslipidemia or obesity. Obesity played a predominant role in the development of MetS. Early obesity intervention was extremely important for MetS prevention.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5599-y) contains supplementary material, which is available to authorized users.