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



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.


Nutrition 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.


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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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