Background: Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent condition strongly associated with obesity. NAFLD is characterized by the presence of fatty deposits in the liver and can result in premature death. Little is known about a symptoms experience in this progressive disease, preventing health-care providers from intervening in the early stages of the disease. Hypothesis: The purpose of this study is to explicate symptoms and health-related quality of life (HRQOL) in persons with NAFLD hypothesized to be at higher risk of disease progression based on PNPLA3 (rs738409) genotype. Methods: A cross-sectional descriptive design, guided by the symptoms experience model, was used to recruit 42 persons 21 years of age or older with diagnosed NAFLD from gastroenterology and bariatric surgery offices in western Michigan. Genotyping for the presence of PNPLA3 gene, (rs738409)-G allele was used to stratify the population. The Memorial Symptom Assessment Scale (MSAS), the Charlson Comorbidity Index, and the Centers of Disease Control and Prevention's Healthy Days Measure were used to measure symptoms, comorbid conditions, and HRQOL. Multiple linear regression techniques were used to analyze the data using PASW 17 software. Results: Frequency of the G allele was .369. Participants (97%) experienced one or more symptoms (M = 12.02, SD = 8.817). Significant predictors were obtained for mean frequency, severity, and distress of symptoms using the subscales of the Memorial Symptom Assessment Scales [TMSAS] (F = 2.609, df1 = 15, df2 = 25, p = .016), Overall distress [MSAS-GDI] (F = 3.331, df1 = 15, df2 = 25, p = .004), Physical subscale [MSAS-PHYS] (F = 2.726, df1 = 15, df2 = 25; p = .013), and Psychological subscale [MSAS-PSYCH] (F = 2.944, df1 = 15, df2 = 25; p = .008). The frequency, intensity, and distress of symptoms did not differ according to PNPLA3 (rs738409) genotype. However, persons with one or two copies of the PNPLA3 gene, (rs738409)-G allele had poorer HRQOL than persons with no copies of the PNPLA3 gene, (rs738409)-G allele (F = 5.068, df1 = 15, df2 = 25; p < .001). Distress of symptoms greatly influenced HRQOL when the PNPLA3 gene, (rs738409)-G allele was removed (F = 11.057, df1 = 15, df2 = 39, p < .001). Clinical Implications: Persons with NAFLD experience symptoms and have nearly 3 times poorer HRQOL than the general U.S. population. The critical role of nursing in treating the human response derived from increased symptoms and poorer HRQOL is key to optimizing health in all stages of the NAFLD disease trajectory. The CDC Healthy Days tool along with the MSAS would be beneficial in screening NAFLD patients for changes in health before and after nursing interventions, and they may be beneficial in preliminary screening of obese patients for the presence of NAFLD. Research Implications: Studies with larger sample sizes are needed to explicate symptoms in persons with NAFLD. In addition, longitudinal studies of symptoms with a larger population are needed to explicate the symptoms experience in persons with NAFLD over time and through the disease trajectory. Further research is needed to determine the genetic contribution to symptom production in persons with NAFLD.
Read
