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About seven out of ten patients (69%) who suffer from non-alcoholic fatty liver disease (NAFLD) perceive some stigmatization in their daily life, according to a study led by a team of the University of Barcelona, the Liver and Digestive Diseases Networking Biomedical Research Centre (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 ONE, the stigma these patients perceive is also associated with the impaired quality of life which is common in people affected by NAFLD.

Stigma in liver diseases

Liver diseases are considered to be stigmatized —a well-documented problem in certain pathologies—, probably because they are associated with alcoholism and drug abuse. Some studies showed that patients affected by hepatitis C and B are often stigmatized regardless of the method of transmission of the virus, sore throat from motrin while patients with liver cirrhosis are also stigmatized regardless of the etiology of the disease. However, there is little information on the stigma in patients with non-alcoholic fatty liver disease. Therefore, the study aimed to finding the frequency and features of the perceived stigma among patients with NAFLD.

The non-alcoholic fatty liver disease is the most common liver pathology worldwide —it affects nearly the 24% of the world population— and it is often associated with obesity and the metabolic syndrome. A significant part of the patients affected by this progressive disease evolve from a simple steatosis to cirrhosis or hepatocellular carcinoma.

It is possible for NAFLD to be a stigmatized disease because it affects the liver and it is usually linked to obesity, two conditions which are common drivers of stigma. "

Marta Carol, researcher, UB-CIBEREHD-CLINIC-IDIBAPS and one of the principal 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 them being affected by NAFLD and 53 with alcohol-related cirrhosis. Since NAFLD is usually associated with an impaired quality of life, they also explored the potential relationship between the perceived stigma and the quality of life of these patients. The perceived stigma was evaluated through a specific questionnaire listed in four domains: stereotypes, discrimination, shame, and social isolation.

Stereotypes, discrimination, shame and social isolation

The 69% of the NAFLD patients feel stigmatized, a condition that affects the four analysed domains, according to the conclusions. Among the patients with NAFLD, the feeling of stigma was higher in patients whose disease had evolved to cirrhosis (72%) compared to patients without cirrhosis (67%).

Among the patients with cirrhosis, stigmatization was more common in alcohol-related cirrhosis than in NAFLD, although the differences were significant in two domains. Moreover, in patients with NAFLD, the perceived stigma corresponded to a bad quality of life.

"Stigmatization is a relevant issue in many diseases due to its potential negative impact on the mental status of the patients, plus it reduces 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, Hospital Clinic and IDIBAPS, and one of the coordinators of the research. "In these recent years, there has been a growing interest in the fight against stigmatization of certain diseases to improve the social acceptance of patients and overall health status", notes Ginès.

"The perceived stigmatization —says the research team— is common among patients with NAFLD regardless of the stage of their disease, it is associated with an impaired quality of life and can be the cause for stereotypes, discrimination, shame and social isolation, which can affect the patients' human and social rights".

Therefore, "the results of this study represent a warning sign on the importance of this perceived stigma in patients with NAFLD, which has consequences in sensitive areas of life. We believe that healthcare professionals, patients associations, and policymakers must consider these findings to promote research and encourage initiatives aimed at preventing discrimination of people affected by this disease", conclude the authors.