Abstract
Background
The role of customary diet and physical activity in development of advanced HCV-related liver disease is not well-established.
Methods
We conducted a retrospective association study in 91 male veterans with PCR-confirmed chronic HCV and biopsy-determined hepatic pathology. Respondents completed the Block Food Frequency and the International Physical Activity questionnaires. We conducted three independent assessments based on hepatic pathology: fibrosis (advanced = F3–F4 vs. mild = F1–F2), inflammation (advanced = A2–A3 vs. mild = A1) and steatosis (advanced = S2–S3 vs. mild = S1). Each assessment compared estimated dietary intake and physical activity in veterans with advanced disease to that in analogous veterans with mild disease. Multivariate models adjusted for total calories, age, race/ethnicity, biopsy-to-survey lag-time, BMI, pack-years smoking, and current alcohol use.
Results
Average veteran age was 52, with 48% African-American. Advanced fibrosis was more prevalent than advanced inflammation or steatosis (52.7% vs. 29.7% vs. 26.4%, respectively). The strongest multivariate association was the suggestive 14-fold significantly decreased advanced fibrosis risk with lowest dietary copper intake (OR = 0.07, 95% CI 0.01–0.60). Other suggestive associations included the 6.5-fold significantly increased advanced inflammation risk with lower vitamin E intake and 6.2-fold significantly increased advanced steatosis risk with lower riboflavin intake. The only physical activity associated with degree of hepatic pathology was a two-fold greater weekly MET-minutes walking in veterans with mild compared to advanced steatosis (P = 0.02).
Conclusions
Several dietary factors and walking may be associated with risk of advanced HCV-related liver disease in male veterans. However, given our modest sample size, our findings must be considered as provisional pending verification in larger prospective studies.
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Abbreviations
- FFQ:
-
Food Frequency Questionnaire
- HCV:
-
Hepatitis C virus
- IPAQ-sf:
-
International Physical Activity Questionnaire, short form
- MEDVAMC:
-
Michael E. DeBakey VA Medical Center
- MET:
-
Metabolic equivalent of task
- VA:
-
Department of Veteran Affairs
References
Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–714.
Heron M, Hoyert DL, Murphy SL, Xu J, Kochanek KD, Tejada-Vera B. Deaths: final data for 2006. Natl Vital Stat Rep. 2009;57:1–134.
Wiesner RH, Sorrell M, Villamil F. Report of the first International Liver Transplantation Society expert panel consensus conference on liver transplantation and hepatitis C. Liver Transpl. 2003;9:S1–S9.
Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004;127:S35–S50.
Kallwitz ER, Layden-Almer J, Dhamija M, Berkes J, Guzman G, Lepe R, Cotler SJ, Layden TJ. Ethnicity and body mass index are associated with hepatitis C presentation and progression. Clin Gastroenterol Hepatol. 2010;8:72–78.
Everhart JE, Lok AS, Kim HY, et al. Weight-related effects on disease progression in the hepatitis C antiviral long-term treatment against cirrhosis trial. Gastroenterology. 2009;137:549–557.
Hu SX, Hu SX, Kyulo NL, Xia VW, Hillebrand DJ, Hu KQ. Factors associated with hepatic fibrosis in patients with chronic hepatitis C: a retrospective study of a large cohort of U.S. patients. J Clin Gastroenterol. 2009;43:758–764.
Alsatie M, Kwo PY, Gingerich JR, et al. A multivariable model of clinical variables predicts advanced fibrosis in chronic hepatitis C. J Clin Gastroenterol. 2007;41:416–421.
Leandro G, Mangia A, Hui J, et al. Relationship between steatosis, inflammation, and fibrosis in chronic hepatitis C: a meta-analysis of individual patient data. Gastroenterology. 2006;130:1636–1642.
Friedenberg F, Pungpapong S, Zaeri N, Braitman LE. The impact of diabetes and obesity on liver histology in patients with hepatitis C. Diabetes Obes Metab. 2003;5:150–155.
Corrao G, Lepore AR, Torchio P, Galatola G, Arico S, di OF. Interaction between dietary pattern and alcohol intake on the risk of liver cirrhosis. The Provincial Group for the Study of Chronic Liver Disease. Rev Epidemiol Sante Publique. 1995;43:7–17.
Corrao G, Torchio P, Zambon A, D’Amicis A, Lepore AR, di Orio F. Alcohol consumption and micronutrient intake as risk factors for liver cirrhosis: a case–control study. The Provincial Group for the study of Chronic Liver Disease. Ann Epidemiol. 1998;8:154–159.
Corrao G, Zambon A, Bagnardi V, Arico S, Loguercio C, D’Amicis A. Nutrient intakes, nutritional patterns and the risk of liver cirrhosis: an explorative case–control study. Eur J Epidemiol. 2004;19:861–869.
Bridges FS. Relationship between dietary beef, fat, and pork and alcoholic cirrhosis. Int J Environ Res Public Health. 2009;6:2417–2425.
Nanji AA, French SW. Relationship between pork consumption and cirrhosis. Lancet. 1985;1:681–683.
Rotily M, Durbec JP, Berthezene P, Sarles H. Diet and alcohol in liver cirrhosis: a case–control study. Eur J Clin Nutr. 1990;44:595–603.
Loguercio C, Federico A, Masarone M, Torella R, Blanco CV, Persico M. The impact of diet on liver fibrosis and on response to interferon therapy in patients with HCV-related chronic hepatitis. Am J Gastroenterol. 2008;103:3159–3166.
National Center for Veterans Analysis and Statistics. VA stats at a glance. http://www1.va.gov/vetdata/docs/4X6_summer09_sharepoint.pdf; 2009.
Dominitz JA, Boyko EJ, Koepsell TD, et al. Elevated prevalence of hepatitis C infection in users of United States veterans medical centers. Hepatology. 2005;41:88–96.
Alter MJ, Kruszon-Moran D, Nainan OV, et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med. 1999;341:556–562.
Satia-Abouta J, Galanko JA, Potter JD, et al. Associations of total energy and macronutrients with colon cancer risk in African Americans and Whites: results from the North Carolina colon cancer study. Am J Epidemiol. 2003;158:951–962.
Block G, Woods M, Potosky A, Clifford C. Validation of a self-administered diet history questionnaire using multiple diet records. J Clin Epidemiol. 1990;43:1327–1335.
Boucher B, Cotterchio M, Kreiger N, Nadalin V, Block T, Block G. Validity and reliability of the Block98 food-frequency questionnaire in a sample of Canadian women. Public Health Nutr. 2006;9:84–93.
National Academy of Sciences, Institute of Medicine, Food and Nutrition Board. Dietary reference intakes: the essential guide to nutrient requirements. Washington, DC: National Academies Press; 2006.
Craig CL, Marshall AL, Sjostrom M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–1395.
Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group. Hepatology. 1994;20:15–20.
Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94:2467–2474.
Willett W. Nutritional epidemiology, 2nd ed. New York: Oxford University Press; 1998.
Freedman ND, Everhart JE, Lindsay KL, et al. Coffee intake is associated with lower rates of liver disease progression in chronic hepatitis C. Hepatology. 2009;50:1360–1369.
Modi AA, Feld JJ, Park Y, et al. Increased caffeine consumption is associated with reduced hepatic fibrosis. Hepatology. 2010;51:201–209.
Vazquez-Vandyck M, Roman S, Vazquez JL, et al. Effect of Breathwalk on body composition, metabolic and mood state in chronic hepatitis C patients with insulin resistance syndrome. World J Gastroenterol. 2007;13:6213–6218.
Payen JL, Pillard F, Mascarell V, Riviere D, Couzigou P, Kharlov N. Is physical activity possible and beneficial for patients with hepatitis C receiving pegylated interferon and ribavirin therapy? Gastroenterol Clin Biol. 2009;33:8–14.
Jenab M, Slimani N, Bictash M, Ferrari P, Bingham SA. Biomarkers in nutritional epidemiology: applications, needs and new horizons. Hum Genet. 2009;125:507–525.
Acknowledgments
This material is based upon work supported in part by VA Clinical Research Merit Review grant H-22934 from the Department of Veteran Affairs (PI: H. B. El-Serag, MD, MPH), a Houston VA Locally Initiated Pilot grant (PI: D. White, PhD), and the Houston VA HSR&D Center of Excellence (HFP90-020). Dr. White receives partial salary support from a Career Development Award (DK081736-01) and Dr. El-Serag from an Advanced Career Development Award (DK078154-03).
Conflict of interest
The authors declare no conflict of interest. The National Institutes of Health, the National Institute of Diabetes Digestive and Kidney Disease, and the U.S. Department of Veteran Affairs played no role in design, implementation, analysis, interpretation or decision to report these results.
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White, D.L., Richardson, P.A., Al-Saadi, M. et al. Dietary History and Physical Activity and Risk of Advanced Liver Disease in Veterans with Chronic Hepatitis C Infection. Dig Dis Sci 56, 1835–1847 (2011). https://doi.org/10.1007/s10620-010-1505-x
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DOI: https://doi.org/10.1007/s10620-010-1505-x