Dietary History and Physical Activity and Risk of Advanced Liver Disease in Veterans with Chronic Hepatitis C Infection
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The role of customary diet and physical activity in development of advanced HCV-related liver disease is not well-established.
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.
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).
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.
KeywordsNutrition assessment Exercise Infectious diseases Military personnel Epidemiology Gastroenterology
Food Frequency Questionnaire
Hepatitis C virus
International Physical Activity Questionnaire, short form
Michael E. DeBakey VA Medical Center
Metabolic equivalent of task
Department of Veteran Affairs
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.
- 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
- 18.National Center for Veterans Analysis and Statistics. VA stats at a glance. http://www1.va.gov/vetdata/docs/4X6_summer09_sharepoint.pdf; 2009.
- 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
- 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