Brief Article
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World J Gastroenterol. Oct 28, 2012; 18(40): 5759-5770
Published online Oct 28, 2012. doi: 10.3748/wjg.v18.i40.5759
Nutritional status in relation to lifestyle in patients with compensated viral cirrhosis
Fumikazu Hayashi, Chika Momoki, Miho Yuikawa, Yuko Simotani, Etsushi Kawamura, Atsushi Hagihara, Hideki Fujii, Sawako Kobayashi, Shuji Iwai, Hiroyasu Morikawa, Masaru Enomoto, Akihiro Tamori, Norifumi Kawada, Satoko Ohfuji, Wakaba Fukusima, Daiki Habu
Fumikazu Hayashi, Chika Momoki, Miho Yuikawa, Yuko Simotani, Daiki Habu, Department of Medical Nutrition, Graduate School of Life Science, Osaka City University, Osaka 558-8585, Japan
Etsushi Kawamura, Atsushi Hagihara, Hideki Fujii, Sawako Kobayashi, Shuji Iwai, Hiroyasu Morikawa, Masaru Enomoto, Akihiro Tamori, Norifumi Kawada, Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan
Satoko Ohfuji, Wakaba Fukusima, Department of Public Health, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan
Author contributions: Hayashi F performed the research and wrote the manuscript; Yuikawa M and Simotani Y performed the research; Kawamura E, Hagihara A, Fujii H, Kobayashi S, Iwai S, Morikawa H, Enomoto M, Tamori A and Kawada N introduced the patients to the study and received the agreements of all participating patients; Momoki C, Ohfuji S and Fukusima W supported the study and performed statistical analysis; Habu D designed the study.
Supported by Japan Nutritional Study Group for Liver cirrhosis 2008, No. JNUS2008; and Health Labor Sciences Research Grant from the Ministry of Health, Labor and Welfare, Japan, No. H20-Hepatitis-General-005
Correspondence to: Daiki Habu, MD, Professor of Life Science, Department of Medical Nutrition, Graduate School of Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka 558-8585, Japan. habu@life.osaka-cu.ac.jp
Telephone: +81-6-66052892 Fax: +81-6-66052892
Received: May 3, 2012
Revised: June 20, 2012
Accepted: June 28, 2012
Published online: October 28, 2012
Abstract

AIM: To assess the nourishment status and lifestyle of non-hospitalized patients with compensated cirrhosis by using noninvasive methods.

METHODS: The subjects for this study consisted of 27 healthy volunteers, 59 patients with chronic viral hepatitis, and 74 patients with viral cirrhosis, from urban areas. We assessed the biochemical blood tests, anthropometric parameters, diet, lifestyle and physical activity of the patients. A homeostasis model assessment-insulin resistance (HOMA-IR) value of ≥ 2.5 was considered to indicate insulin resistance. We measured height, weight, waist circumference, arm circumference, triceps skin-fold thickness, and handgrip strength, and calculated body mass index, arm muscle circumference (AMC), and arm muscle area (AMA). We interviewed the subjects about their dietary habits and lifestyle using health assessment computer software. We surveyed daily physical activity using a pedometer. Univariate and multivariate logistic regression modeling were used to identify the relevant factors for insulin resistance.

RESULTS: The rate of patients with HOMA-IR ≥ 2.5 (which was considered to indicate insulin resistance) was 14 (35.9%) in the chronic hepatitis and 17 (37.8%) in the cirrhotic patients. AMC (%) (control vs chronic hepatitis, 111.9% ± 10.5% vs 104.9% ± 10.7%, P = 0.021; control vs cirrhosis, 111.9% ± 10.5% vs 102.7% ± 10.8%, P = 0.001) and AMA (%) (control vs chronic hepatitis, 128.2% ± 25.1% vs 112.2% ± 22.9%, P = 0.013; control vs cirrhosis, 128.2% ± 25.1% vs 107.5% ± 22.5%, P = 0.001) in patients with chronic hepatitis and liver cirrhosis were significantly lower than in the control subjects. Handgrip strength (%) in the cirrhosis group was significantly lower than in the controls (control vs cirrhosis, 92.1% ± 16.2% vs 66.9% ± 17.6%, P < 0.001). The results might reflect a decrease in muscle mass. The total nutrition intake and amounts of carbohydrates, protein and fat were not significantly different amongst the groups. Physical activity levels (kcal/d) (control vs cirrhosis, 210 ± 113 kcal/d vs 125 ± 74 kcal/d, P = 0.001), number of steps (step/d) (control vs cirrhosis, 8070 ± 3027 step/d vs 5789 ± 3368 step/d, P = 0.011), and exercise (Ex) (Ex/wk) (control vs cirrhosis, 12.4 ± 9.3 Ex/wk vs 7.0 ± 7.7 Ex/wk, P = 0.013) in the cirrhosis group was significantly lower than the control group. The results indicate that the physical activity level of the chronic hepatitis and cirrhosis groups were low. Univariate and multivariate logistic regression modeling suggested that Ex was associated with insulin resistance (odds ratio, 6.809; 95% CI, 1.288-36.001; P = 0.024). The results seem to point towards decreased physical activity being a relevant factor for insulin resistance.

CONCLUSION: Non-hospitalized cirrhotic patients may need to maintain an adequate dietary intake and receive lifestyle guidance to increase their physical activity levels.

Keywords: Hepatitis C virus; Insulin resistance; Liver cirrhosis; Nutrition assessment; Obesity; Lifestyle; Exercise