The limited heterogeneous literatur

The limited heterogeneous literature meant that the level ofdetail in the reporting varied greatly between studies, whichmade synthesis difficult. Studies were included even if they didnot refer solely to NASH-cirrhosis. This is because several studiesreported findings correlating with the severity but not the aetiology of liver disease.From the included studies, several common themes can beidentified. Where reported, type 2 diabetes was cited as the maincomorbidity for patients with liver disease, this was followed byobesity. Obesity and insulin resistance are well documented riskfactors for developing NAFLD and approximately 85% of NAFLDpatients will also have one of these comorbidities.71 Severalsymptoms were reported as being problematic for patients withliver disease, these included: abdominal pain, general pain, lackof energy, tiredness and sleep symptoms. Frequent comorbidconditions raise the possibility that patient burden is impactedby an illness other than NASH. However, due to associated conditions (e.g. overweight and diabetes) and the high prevalence ofother comorbidities, it is challenging to assert that effects aresolely down to NASH