Clinical

REFILE: Fatigue in non-alcoholic fatty liver disease not caused only by weight

Last Updated: 2008-06-30 10:06:20 -0400 (Reuters Health)

[Corrects story posted Jun 6, 2008. In paragraph 4, NAFLS has been changed to NAFLD]

NEW YORK (Reuters Health) - Fatigue, a significant problem in patients with non-alcoholic fatty liver disease (NAFLD), cannot be attributed merely to weight problems, according to a report in the June issue of Gut.

"Fatigue is a problem in NAFLD; it is real and should be treated as such," Dr. Julia L. Newton from University of Newcastle, UK told Reuters Health. "Fatigue may have implications in the management of those with NAFLD."

In 156 patients with histologically proven NAFLD, Dr. Newton and colleagues assessed fatigue severity and explored its potential causes. The authors explain that an association between NAFLD and increased body mass index frequently leads to an assumption that patients' fatigue is related to excess weight.

Compared to controls who were matched for body mass (as well as for age and gender), however, patients with NAFLD had significantly higher scores on the Fatigue Impact Scale. Also, NAFLD patients were significantly less active than controls. Activity levels were inversely correlated with fatigue severity.

Fatigue severity did not correlate with liver function test results, immunoglobulin levels, or degree of insulin resistance, the investigators say, nor with the severity of steatosis, fibrosis, or presence of hepatocyte injury.

There was, however, a strong correlation between fatigue scores and Epworth Sleepiness Score, the researchers note, "suggesting that increasing fatigue is associated with excessive daytime somnolence."

"This study has gone some way to refute the misconception that symptoms such as fatigue are related entirely to excess weight," the authors note, "and may now allow directed studies into the pathogenesis of fatigue in NAFLD."

"Fatigue is unrelated to the severity of the underlying liver disease -- so treatment of the liver will not necessarily improve the symptoms that are impacting upon...quality of life," Dr. Newton said.

To address fatigue in these patients, she recommends: "Think secondary causes; review medication (any vasoactive medications that can be stopped); consider sleep problems; and think autonomic dysfunction."

Gut 2008;57:807-813.