title: Nutritional status in relation to lifestyle in patients with compensated viral cirrhosis.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Non-hospitalized cirrhotic patients may need to maintain an adequate dietary intake and receive lifestyle guidance to increase their physical activity levels.
authors.affiliation: Department of Medical Nutrition, Graduate School of Life Science, Osaka City University, Osaka 558-8585, Japan.
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Hayashi
authors.forename: Chika
authors.initials: C
authors.lastname: Momoki
authors.forename: Miho
authors.initials: M
authors.lastname: Yuikawa
authors.forename: Yuko
authors.initials: Y
authors.lastname: Simotani
authors.forename: Etsushi
authors.initials: E
authors.lastname: Kawamura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hagihara
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
authors.forename: Sawako
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Shuji
authors.initials: S
authors.lastname: Iwai
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Morikawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Enomoto
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tamori
authors.forename: Norifumi
authors.initials: N
authors.lastname: Kawada
authors.forename: Satoko
authors.initials: S
authors.lastname: Ohfuji
authors.forename: Wakaba
authors.initials: W
authors.lastname: Fukusima
authors.forename: Daiki
authors.initials: D
authors.lastname: Habu
mesh_terms: D000368:Aged; D000886:Anthropometry; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D016022:Case-Control Studies; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D006521:Hepatitis, Chronic / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007333:Insulin Resistance; D008019:Life Style; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000821:virology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D016017:Odds Ratio; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers