Frailty, non-cirrhotic NAFLD, and exercise: a new model of care?

Article: Prevalence of frailty in patients with non-cirrhotic non-alcoholic fatty liver disease

It is known that advanced liver disease and frailty are heavily interlinked, and frailty’s association with an increased risk of progression to cirrhosis and death has been widely documented. Patients with advanced liver disease who are on waiting lists for liver transplants are urged to increase their physical activity prior to surgery. However, this patient population only represents a minority of liver disease patients.

This article aims to examine the prevalence of frailty in patients with non-cirrhotic non-alcoholic fatty liver disease (NAFLD), and exposes the faults of current models of care for this patient population.

Key learnings:

⅓ of patients with early-stage NAFLD are frail, and another ⅓ are ‘prefrail’. This prevalence, which is already unexpectedly high, is exacerbated in women: frailty is more frequently found in female patients.

Patients with NAFLD are also disproportionately affected by cardiovascular disease, hypertension, type 2 diabetes and hypercholesteremia. These factors, combined with obesity, are thought to drive frailty more than NAFLD itself. As such, lifestyle interventions to improve them are critical to bettering patient outcomes.

Implementing frailty assessments and rehabilitation interventions for frail patients have been both suggested and encouraged by many studies. However, physical exercise interventions prove difficult to implement for frail patients and are not associated with significantly better patient outcomes. As such, physical exercise for patients with non-cirrhotic NAFLD must be encouraged earlier on, before frailty develops. Currently, patients with non-cirrhotic NAFLD are rushed through a model of care which almost entirely excludes lifestyle interventions. Exercise recommendations are often disregarded for this patient group, as they do not possess advanced liver disease. However, it is important to note that these patients still possess reduced overall life-expectancy. A model of care promoting strategies to improve healthy eating, exercise, and rehabilitation early on for patients with non-cirrhotic NAFLD is thus urgently needed.

Reviewed by: S. Duarte

Authors: O’Brien A

Published in: BMJ Open Gastroenterology 2022