Nutritional status in relation to lifestyle in patients with compensated viral cirrhosis

Table 1 Subjects characteristics

	Control	Chronic hepatitis	Cirrhosis
Sex (male/female)	12/15	26/33	25/49
Age (yr)	65.9 ± 6.1	63.5 ± 10.1	68.3 ± 7.5b
Viral infection (HBV/HCV)	-	17/42	11/63
Child-Pugh classification (A/B)	-	-	62/12
Diabetes mellitus	-	11	11
Hypertension	-	20	24
Hyperlipidemia	-	4	6

^bP < 0.01 vs chronic hepatitis. Data are expressed as mean ± SD or as number of patients. Statistical differences among the 3 groups were determined by the Kruskal-Wallis and Scheffe's multiple comparison tests. HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 2 Laboratory evaluations for the patients (mean ± SD)

	Chronic hepatitis	Cirrhosis
WBC (× 100/μL)	55.5 ± 19.2	37.9 ± 13.6a
RBC (× 102/μL)	441 ± 57	399 ± 47a
Hb (g/dL)	13.8 ± 1.5	12.6 ± 1.6a
Ht (%)	40.7 ± 3.9	37.2 ± 4.0a
Plt (× 102/μL)	17.8 ± 3.8	8.6 ± 2.5a
PT (%)	96.9 ± 11.2	83.4 ± 13.2a
TP (g/dL)	7.2 ± 0.5	7.0 ± 0.7b
Alb (g/dL)	4.0 ± 0.4	3.5 ± 0.5a
BUN (mg/dL)	15.6 ± 6.1	15.5 ± 5.6
Cre (mg/dL)	0.77 ± 0.27	0.73 ± 0.24
T-bil (mg/dL)	0.9 ± 0.4	1.1 ± 0.5c
D-bil (mg/dL)	0.3 ± 0.2	0.4 ± 0.3a
AST (IU/L)	44 ± 23	60 ± 39d
ALT (IU/L)	41 ± 27	53 ± 40
AST/ALT	1.2 ± 0.4	1.3 ± 0.5
LAP (IU/L)	59 ± 20	63 ± 17e
γ-GTP (IU/L)	51 ± 85	51 ± 57
ALP (IU/L)	299 ± 144	356 ± 126f
ChE (IU/L)	281 ± 89	201 ± 81a
TG (mg/dL)	102 ± 44	87 ± 31
T-cho (mg/dL)	182 ± 37	155 ± 38a
HbA1c (%)	5.9 ± 0.8	5.2 ± 0.9a
FBS (mg/dL)	99.0 ± 14.1	99.6 ± 14.5
IRI (μU/mL)	11.1 ± 8.2	12.1 ± 11.1
HOMA-IR	2.7 ± 2.2	2.9 ± 2.5
BTR	5.43 ± 1.54	3.90 ± 1.23a
BCAA (μmol/mL)	425 ± 92	387 ± 77g
Tyrosine (μmol/mL)	82 ± 23	107 ± 36a

^aP < 0.05,

^bP = 0.018,

^cP = 0.017,

^dP = 0.008,

^eP = 0.048,

^fP = 0.001,

^gP = 0.025 vs chronic hepatitis. Differences between the 2 groups were analyzed using the Mann-Whitney U test. WBC: Number of white blood cells; RBC: Number of red blood cells; Hb: Hemoglobin; Ht: Hematocrit level; Plt: Platelet count; PT: Prothrombin time; TP: Total protein; Alb: Albumin; BUN: Blood urea nitrogen; Cre: Creatinine; T-bil: Total bilirubin; D-bil: Direct bilirubin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; LAP: Leucine aminopeptidase; γ-GTP: γ-glutamyl transpeptidase; ALP: Alkaline phosphatase; ChE: Cholinesterase; TG: Triglycerides; Total-C: Total cholesterol; HbA1c: Hemoglobin A1c; FBS: Fasting blood sugar; IRI: Immunoreactive insulin levels; HOMA-IR: Homeostasis model assessment-insulin resistance; BCAA: Plasma branched-chain amino acid levels; BTR: Molar ratio of BCAA to tyrosine; Tyrosine: Plasma tyrosine levels.

Table 3 Anthropometric assessments of all subjects

	Control	Chronic hepatitis	Cirrhosis
Height (cm)1
Male	168.2 ± 6.3	168.0 ± 7.6	165.8 ± 6.0
Female	151.0 ± 3.5	152.8 ± 4.1	151.6 ± 6.5
Weight (kg)1
Male	67.0 ± 8.5	67.5 ± 11.0	64.5 ± 9.0
Female	54.5 ± 6.7	54.6 ± 9.4	50.8 ± 8.8
BMI (kg/m2)1
Male	23.7 ± 3.1	23.9 ± 3.1	23.4 ± 2.6
Female	23.9 ± 2.6	23.4 ± 4.0	22.1 ± 3.5
BMI (underweight/normal/obese)2
Male	1/5/5	1/17/9	0/16/8
Female	1/8/7	2/17/13	6/36/8h
Abdominal circumference (cm)1
Male	86.3 ± 7.8	90.0 ± 8.0	87.7 ± 8.6
Female	84.6 ± 10.0	86.0 ± 9.9	85.1 ± 9.2
%AC1	108.1 ± 8.4	107.4 ± 11.8	103.9 ± 11.5
%TSF1	96.0 ± 37.0a	129.0 ± 50.2	116.5 ± 48.4
%AMC1	111.9 ± 10.5be	104.9 ± 10.7	102.7 ± 10.8
%AMA1	128.2 ± 25.1cf	112.2 ± 22.9	107.5 ± 22.5
Hand grip strength (%)1	92.1 ± 16.2dg	74.4 ± 20.9	66.9 ± 17.6

^aP = 0.013,

^bP = 0.021,

^cP = 0.013,

^dP < 0.001 vs chronic hepatitis;

^eP = 0.001,

^fP = 0.001,

^gP < 0.001 vs liver cirrhosis;

^hP = 0.007. Data are expressed as mean ± SD or as number of patients. ^1,2Statistical differences among the 3 groups were determined by the Kruskal-Wallis and Scheffe's multiple comparison tests¹ or Spearman's rank correlation coefficient². BMI: Body mass index; AC: Arm circumference; TSF: Triceps skin fold thickness; AMC: Arm muscle circumference; AMA: Arm muscle area.

Table 4 The dietary surveys of all subjects (mean ± SD)

	Control	Chronic hepatitis	Cirrhosis
Energy intake (kcal)	1814 ± 400	1768 ± 470	1730 ± 468
Energy intake (kcal/BW)	31.0 ± 7.5	30.0 ± 8.6	32.0 ± 9.0
Carbohydrate percentage (%)	57.9 ± 7.1	59.1 ± 9.1	60.1 ± 8.9
Protein percentage (%)	15.9 ± 2.9	16.2 ± 2.8	16.2 ± 3.0
Fat percentage (%)	26.1 ± 7.1	24.8 ± 8.4	23.7 ± 8.8
Carbohydrate intake (g)	248.9 ± 57.4	254.9 ± 76.5	251.2 ± 67.9
Protein intake (g)	68.0 ± 17.1	68.3 ± 17.1	70.0 ± 19.5
Protein intake (g/BW)	1.2 ± 0.3	1.2 ± 0.4	1.3 ± 0.4
Fat intake (g)	50.5 ± 19.5	47.4 ± 21.4	46.7 ± 24.4
Calcium intake (mg)	544 ± 198	513 ± 170	536 ± 216
Iron intake (mg)	7.9 ± 2.7	7.4 ± 1.8	7.2 ± 2.5
Salt intake (g)	8.7 ± 2.3	8.7 ± 2.9	8.5 ± 2.3
Vitamin A intake (μgRE)	1015 ± 391	1046 ± 512	979 ± 478
Vitamin B1 intake (mg)	0.8 ± 0.4	0.8 ± 0.3	0.9 ± 0.4
Vitamin B2 intake (mg)	1.1 ± 0.3	1.2 ± 0.5	1.1 ± 0.4
Vitamin C intake (mg)	114 ± 66	148 ± 191	118 ± 64
Dietary fiber intake (mg)	14.3 ± 4.3	13.9 ± 4.1	14.0 ± 3.8
Grains (g)	402.5 ± 111.2	449.5 ± 173.4	416.3 ± 133.0
Green and yellow vegetables (g)	121.4 ± 76.1	143.6 ± 170.7	137.8 ± 96.8
Light-colored vegetables (g)	187.1 ± 128.3	165.8 ± 73.0	167.1 ± 78.5
Tubers and roots (g)	65.8 ± 68.1	38.1 ± 50.5	37.2 ± 44.0
Meat (g)	51.9 ± 67.5	67.8 ± 67.2	66.8 ± 73.5
Seafood (g)	97.4 ± 71.4	82.0 ± 56.0	73.3 ± 56.1
Egg (g)	37.4 ± 36.2	40.0 ± 38.9	27.0 ± 26.7
Pulses (g)	61.9 ± 64.1	57.0 ± 59.3	65.6 ± 72.3
Milk and daily product (g)	124.9 ± 119.5	130.1 ± 117.7	142.3 ± 132.1
Fruit (g)	114.5 ± 113.8	109.2 ± 192.1	129.1 ± 128.8
Oil and fat (g)	11.3 ± 10.9	11.9 ± 11.6	9.4 ± 11.6

Statistical differences among the 3 groups were determined by the Kruskal-Wallis and Scheffe's multiple comparison tests. BW: Body weight; RE: Retinol equivalents.

Table 5 The lifestyle surveys of all subjects

	Control	Chronic hepatitis	Cirrhosis	P value
Drinking habit2				< 0.001
Nothing	10 (8.8)	40 (67.8)	63 (85.1)
Sometimes	6 (22.2)	11 (18.6)	9 (12.2)
Daily	11 (40.7)	8 (13.6)	2 (2.7)
Alcohol intake (g/d)1	13.7 ± 26.6a	4.9 ± 14.2	1.6 ± 9.9
Stage model of alcohol drinking2				0.141
Maintenance	4 (23.5)	7 (36.8)	4 (36.4)
Action	1 (5.9)	1 (5.3)	0 (0)
Sometimes	3 (17.6)	6 (31.6)	5 (45.5)
Preparation	0 (0)	1 (5.3)	0 (0)
Contemplation	9 (52.9)	2 (10.5)	1 (9.1)
Pre-contemplation	0 (0)	2 (10.5)	1 (9.1)
Experience of dieting2				0.258
No	21 (77.8)	37 (62.7)	59 (79.7)
Yes	6 (22.2)	22 (37.3)	15 (20.3)
Stage model of dietary habit2
Maintenance	6 (22.2)	10 (16.9)	12 (16.2)	0.540
Action	2 (7.4)	1 (1.7)	2 (2.7)
Preparation	2 (7.4)	13 (22)	11 (14.9)
Contemplation	9 (33.3)	7 (11.9)	19 (25.7)
Pre-contemplation	8 (29.6)	28 (47.5)	30 (40.5)
Eating speed (eating lunch within 10 min)2
Fast	8 (29.6)	22 (37.3)	20 (27)	0.451
General or slow	19 (70.4)	37 (62.7)	54 (73)
Eating and drinking
Prior to bedtime2
Yes	6 (22.2)	12 (20.3)	16 (21.6)	0.975
No	21 (77.8)	47 (79.7)	58 (78.4)
Skipping a meal2
Yes	4 (14.8)	18 (30.5)	14 (18.9)	0.700
No	23 (85.2)	41 (69.5)	60 (81.1)
Resting2
Enough	9 (33.3)	38 (64.4)	49 (66.2)	0.026
Almost enough	9 (33.3)	4 (6.8)	11 (14.9)
A little shortage	7 (25.9)	14 (23.7)	10 (13.5)
Shortage	2 (22.2)	3 (5.1)	4 (5.4)
Sleeping time (h)1	6.7 ± 1.1b	6.8 ± 1.5c	7.6 ± 1.6
Perceived health status2				< 0.001
Very healthy	2 (7.4)	4 (6.8)	3 (4.1)
Almost healthy	23 (85.2)	32 (54.2)	28 (37.8)
A little unhealthy	2 (7.4)	18 (30.5)	34 (45.9)
Unhealthy	0 (0)	5 (8.5)	9 (12.2)
Stage model of exercise2				0.630
Maintenance	12 (44.4)	23 (39)	27 (36.5)
Action	0 (0)	0 (0)	0 (0)
Preparation	4 (14.8)	5 (8.5)	13 (17.6)
Contemplation	10 (37)	23 (39)	25 (33.8)
Pre-contemplation	1 (3.7)	8 (13.6)	9 (12.2)
Smoking custom2				0.140
Yes	5 (18.5)	13 (22)	8 (10.8)
No	22 (81.5)	46 (78)	66 (89.2)
Time to smoking cigarette first after it get out of bed2				0.555
Within 5 min	2 (40)	1 (7.1)	1 (14.3)
From 6 to 30 min	1 (20)	1 (7.1)	1 (14.3)
From 31 to 60 min	2 (40)	4 (28.6)	4 (57.1)
More than 61 min	0 (0)	8 (57.1)	1 (14.3)
Number of smoking cigarettes on a day2				0.584
Less than 10 cigarettes	3 (60)	3 (21.4)	2 (28.6)
From 10 to 20 cigarettes	2 (40)	7 (50)	5 (71.4)
From 21 to 30 cigarettes	0 (0)	3 (21.4)	0 (0)
More than 31cigarettes	0 (0)	1 (7.1)	0 (0)
Period of no smoking2				0.356
More than 10 yr	3 (60)	11 (61.1)	16 (72.7)
From 3 to 10 yr	0 (0)	6 (33.3)	4 (18.2)
From 1 to 3 yr	1 (20)	0 (0)	1 (4.5)
From 6 mo to less than 1 yr	1 (20)	1 (5.6)	1 (4.5)
Stage model of smoking2				0.481
Maintenance	5 (50)	19 (59.4)	22 (71)
Action	0 (0)	0 (0)	0 (0)
Preparation	0 (0)	0 (0)	3 (9.7)
Contemplation	4 (40)	7 (21.9)	3 (9.7)
Pre-contemplation	1 (10)	6 (18.8)

^aP = 0.003,

^bP = 0.028,

^cP = 0.007 vs liver cirrhosis. Data are expressed as mean ± SD or as number of patients. ^1,2Statistical differences among the 3 groups were determined by the Kruskal-Wallis and Scheffe's multiple comparison tests¹ or Spearman's rank correlation coefficient².

Table 6 The physical activity surveys of the subjects (mean ± SD)

	Control	Chronic hepatitis	Cirrhosis
n	27	43	53
TEE (kcal/d)	1781 ± 272d	1732 ± 305h	1593 ± 220
Physical activity (kcal/d)	210 ± 113ae	151 ± 95	125 ± 74
Number of steps (step/d)	8070 ± 3027bf	6011 ± 2952	5789 ± 3368
Ex (Ex/wk)	12.4 ± 9.3cg	7.6 ± 6.3	7.0 ± 7.7

^aP = 0.035,

^bP = 0.032,

^cP = 0.038 vs chronic hepatitis;

^dP = 0.013,

^eP = 0.001,

^fP = 0.011,

^gP = 0.013,

^hP = 0.042 vs liver cirrhosis. Statistical differences among the 3 groups were determined by the Kruskal-Wallis and Scheffe's multiple comparison tests. TEE: Total energy expenditure; Ex: Exercise.

Table 7 Logistic regression model of insulin resistance in patients with chronic liver disease

	Control (n)	Case (n)	Univariate		Multivariate
			Odds ratio (95% CI)	P value	Odds ratio1 (95% CI)	P value
Viral infection
HBV infection	15	3	1	0.055
HCV infection	38	28	3.684 (0.972-13.960)
Groups
Chronic hepatitis	25	14	1	0.859
Liver cirrhosis	28	17	1.084 (0.445-2.639)
The hepatocellular carcinoma
Absent	44	19	1	0.030	1	0.290
Present	9	12	3.087 (1.115-8.544)		0.311 (0.036-2.713)
Sex
Female	35	18	1	0.466	1	0.700
Male	18	13	1.404 (0.564-3.496)		0.712 (0.126-4.010)
Age (yr)
< 65	23	14	1	0.875	1	0.366
≥ 65	30	17	0.931 (0.382-2.271)		0.486 (0.102-2.324)
%AC
≥ 100	33	26	1	0.042	1	0.091
< 100	20	5	0.317 (0.105-0.960)		0.223 (0.039-1.271)
%TSF
≥ 100%	31	24	1	0.083
< 100%	22	7	0.411 (0.151-1.121)
%AMC
≥ 100%	35	22	1	0.641
< 100%	18	9	0.795 (0.304-2.081)
%AMA
≥ 100%	38	22	1	0.943
< 100%	15	9	1.036 (0.389-2.759)
Handgrip strength (%)
≥ 69.0	22	17	1	0.360
< 69.0	30	13	1.526 (0.617-3.771)
Ex (Ex/wk)
≥ 4.0	29	7	1	0.003	1	0.024
< 4.0	10	14	5.800 (1.823-18.455)		6.809 (1.288-36.001)
Plt (× 102/μL)
≥ 10.0	37	15	1	0.054
< 10.0	16	16	2.466 (0.986-6.168)
Alb (g/dL)
≥ 3.5	43	20	1	0.094
< 3.5	10	11	2.365 (0.864-6.476)
BTR
≥ 4.41	31	11	1	0.025	1	0.238
< 4.41	17	18	2.984 (1.148-7.756)		2.770 (0.509-15.061)
Energy intake per BW (kcal/BW)
≤ 30	21	22	1	0.007	1	0.602
> 30	32	9	0.268 (0.104-0.695)		0.689 (0.171-2.785)
Protein intake per BW (g/BW)
≤ 1.2	24	17	1	0.339
> 1.2	29	14	0.682 (0.280-1.660)
Fat percentage (%)
≤ 25	26	23	1	0.027	1	0.096
> 25	27	8	0.335 (0.127-0.882)		0.222 (0.038-1.307)

¹Adjusted for the presence or absence of hepatocellular carcinoma, arm circumference (AC), exercise (Ex), molar ratio of branched-chain amino acid to tyrosine (BTR), total energy intake per body weight (BW), and percentage fat, age. HBV: Hepatitis B virus; HCV: Hepatitis C virus; TSF: Triceps skin fold thickness; AMC: Arm muscle circumference; AMA: Arm muscle area; Plt: Platelet count; Alb: Albumin.