Digestive Diseases and Sciences

, Volume 56, Issue 6, pp 1835–1847 | Cite as

Dietary History and Physical Activity and Risk of Advanced Liver Disease in Veterans with Chronic Hepatitis C Infection

  • Donna L. White
  • Peter A. Richardson
  • Mukhtar Al-Saadi
  • Stephanie J. Fitzgerald
  • Linda Green
  • Chami Amaratunge
  • Manvir Anand
  • Hashem B. El-Serag
Original Article

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.

Keywords

Nutrition assessment Exercise Infectious diseases Military personnel Epidemiology Gastroenterology 

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

Notes

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.

References

  1. 1.
    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.PubMedGoogle Scholar
  2. 2.
    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.PubMedGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004;127:S35–S50.PubMedCrossRefGoogle Scholar
  5. 5.
    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.Google Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    Bridges FS. Relationship between dietary beef, fat, and pork and alcoholic cirrhosis. Int J Environ Res Public Health. 2009;6:2417–2425.PubMedCrossRefGoogle Scholar
  15. 15.
    Nanji AA, French SW. Relationship between pork consumption and cirrhosis. Lancet. 1985;1:681–683.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    National Center for Veterans Analysis and Statistics. VA stats at a glance. http://www1.va.gov/vetdata/docs/4X6_summer09_sharepoint.pdf; 2009.
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedCrossRefGoogle Scholar
  24. 24.
    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.Google Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    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.Google Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    Willett W. Nutritional epidemiology, 2nd ed. New York: Oxford University Press; 1998.CrossRefGoogle Scholar
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    Modi AA, Feld JJ, Park Y, et al. Increased caffeine consumption is associated with reduced hepatic fibrosis. Hepatology. 2010;51:201–209.PubMedGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    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.PubMedCrossRefGoogle Scholar
  33. 33.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC (Outside the USA) 2010

Authors and Affiliations

  • Donna L. White
    • 1
    • 2
    • 3
    • 4
  • Peter A. Richardson
    • 1
  • Mukhtar Al-Saadi
    • 1
    • 4
  • Stephanie J. Fitzgerald
    • 1
    • 4
  • Linda Green
    • 5
    • 6
  • Chami Amaratunge
    • 2
    • 3
  • Manvir Anand
    • 1
    • 4
  • Hashem B. El-Serag
    • 1
    • 2
    • 3
    • 4
  1. 1.Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonUSA
  2. 2.Section of Gastroenterology and Hepatology, Department of MedicineBaylor College of MedicineHoustonUSA
  3. 3.Section of Gastroenterology and HepatologyMichael E. DeBakey Veteran Affairs Medical CenterHoustonUSA
  4. 4.Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of ExcellenceMichael E. DeBakey Veteran Affairs Medical CenterHoustonUSA
  5. 5.Department of PathologyMichael E. DeBakey Veteran Affairs Medical CenterHoustonUSA
  6. 6.Department of PathologyBaylor College of MedicineHoustonUSA

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