Physical activity compared to adiposity and risk of liver-related mortality: Results from two prospective, nationwide cohorts

Simon, Tracey G.; Kim, Seung Up; Luo, Xiao; Yang, Wanshui; Ma, Yanan; Chong, Dawn Q.; Fuchs, Charles S.; Meyerhardt, Jeffrey A.; Corey, Kathleen E.; Chung, Raymond T.; Stampfer, Meir J.; Zhang, Xuehong; Giovannucci, Edward; Chan, Andrew T.

doi:10.1016/j.jhep.2019.12.022

Cited by 40 publications

(23 citation statements)

References 53 publications

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“…Several reports have stressed the prognostic significance of eGFR in CLD patients, which were in agreement with our results (42)(43)(44). While, BMI and WC (adiposity-related markers) were not associated with the OS in our study, although a recent large prospective cohort study demonstrated the prognostic significance of excess adiposity (45). The reason for these discrepancies between studies remains unclear.…”

Section: Discussionsupporting

confidence: 89%

Combined grip strength and calf circumference as a useful prognostic system in patients with liver diseases: a large cohort study

Nishikawa¹,

Enomoto²,

Nishimura³

et al. 2021

Ann Transl Med

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Background: Sarcopenia and body composition can be associated with mortality in chronic liver diseases (CLDs). We sought to identify predictors in CLD patients (n=631, 309 males) and create a prognostic model using easily available indexes.Methods: Reference values for low-grip strength (GS) were 26 kg in men and 18 kg in women. Reference values for low-skeletal muscle index (SMI) were 7.0 kg/m 2 in men and 5.7 kg/m 2 in women using bioelectrical impedance analysis (BIA). Reference values for low-calf circumference (CC) were 34 cm in men and 33 cm in women. Reference values for high-waist circumference were 85 cm in men and 90 cm in women. Using significant factors in the multivariate analysis contributing to the overall survival (OS), we created a simple predictive model. Akaike information criterion (AIC) was compared. Results: Men (P<0.0001), presence of liver cirrhosis (LC) (P<0.0001), presence of hepatocellular carcinoma (HCC) (P<0.0001), low-GS (P<0.0001), low-CC (P<0.0001), serum albumin (P=0.0355), estimated glomerular filtration rate (P=0.0461), hepatitis B virus (P=0.0044) and hepatitis C virus (P<0.0001) were significant factors contributing to the OS by the multivariate analysis. The study subjects were classified into the 4 groups (combined GS-SMI system): (I) low-GS and low-SMI (sarcopenia, n=73); (II) low-GS and high-SMI (n=65); (III) high-GS and low-SMI (n=110); and (IV) high-GS and high-SMI (n=383). The cumulative OS rates were well stratified among 4 groups (overall P<0.0001, AIC =360.895). The study subjects were also classified into the 4 groups (combined GS-CC system): (I) low-GS and low-CC (n=60); (II) low-GS and high-CC (n=78); (III) high-GS and low-CC (n=70); and (IV) high-GS and high-CC (n=423). The cumulative OS rates were also well stratified among 4 groups (overall P<0.0001, AIC =349.521). In receiver operating characteristic (ROC) curve analysis for CC based on the OS, the optimal cutoff point in men was 34.6 cm [area under the ROC (AUC) =0.70, sensitivity =0.558, specificity =0.842], and that in women was 32.8 cm (AUC =0.72, sensitivity =0.619, specificity =0.787).Conclusions: CC can be an alternative marker for muscle mass in CLD patients. Our proposed combined GS-CC system can be helpful in the community settings without special equipment for muscle mass measurement.

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Section: Discussionsupporting

confidence: 89%

Combined grip strength and calf circumference as a useful prognostic system in patients with liver diseases: a large cohort study

Nishikawa¹,

Enomoto²,

Nishimura³

et al. 2021

Ann Transl Med

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“…Our study demonstrates that physical activity is not only associated with reduced liver disease progression, but also linked to reduced liver disease development. Several studies have focused on the role of physical activity in NAFLD, while data on other liver diseases is limited[16]. Our findings suggest…”

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confidence: 54%

Physical activity is associated with reduced risk of liver disease in the prospective UK Biobank cohort

Schneider¹,

Zandvakili²,

Thaiss³

et al. 2021

JHEP Reports

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Studies have reported that reduced PA were positively associated with the prevalence of NAFLD and liver-related mortality. 14,15 In contrast, vigorous-intensity PA reduces the severity of NAFLD. 16 Although the association between lifestyle habits and NAFLD has been well studied, clinicians and policymakers need to identify areas of deficiency so as to prevent and manage NAFLD.…”

Section: Introductionmentioning

confidence: 99%

“…However, physical inactivity has become a serious public health problem for patients with chronic liver diseases. Studies have reported that reduced PA were positively associated with the prevalence of NAFLD and liver‐related mortality 14,15 . In contrast, vigorous‐intensity PA reduces the severity of NAFLD 16 …”

Section: Introductionmentioning

confidence: 99%

Unhealthy lifestyle habits and physical inactivity among Asian patients with non‐alcoholic fatty liver disease

Zhang

Goh

Chan

et al. 2020

Liver International

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Background & Aims: Lifestyle modification is the cornerstone for the management of non-alcoholic fatty liver disease (NAFLD). We aim to understand lifestyle habits of NAFLD patients, compare across Asian regions and identify area of deficiency. Methods: In the multi-centre controlled attenuation parameter (CAP)-Asia study, we collected clinical data and lifestyle habit data of NAFLD patients from Singapore, mainland China, Hong Kong, Taiwan and Malaysia. Physical activity was assessed using the International Physical Activity Questionnaire. Results: A total of 555 patients were included in the final analysis (mean age 54.5 ± 11.2 years, 54.1% men and median liver stiffness 6.7 kPa). More patients from mainland China (27.4%) and Taipei (25.0%) were smokers. Modest drinking was more common in Taiwan (25.0%) and Hong Kong (18.2%); only 1.3% had binge drinking. Majority of patients drank coffee (64.0%) and tea (80.2%), with varying amounts and durations in different regions. Soft drinks consumption was most common in Singapore (62.2%) and Malaysia (57.7%). Only 29.7% of patients met the Physical Activity Guidelines Recommendations, with no major differences across regions. Patients with liver stiffness <10 kPa were more likely to report any vigorous activity, and sitting time was an independent factor associated with high CAP. Tea and coffee consumption were independently associated with high CAP and liver stiffness, respectively. Conclusions: Despite some heterogeneity, unhealthy lifestyle and physical inactivity are common across Asian regions. Patients with liver stiffness <10 kPa were more likely to report any vigorous activity. Healthcare providers may use the comparative data to identify areas of deficiency.

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Physical activity compared to adiposity and risk of liver-related mortality: Results from two prospective, nationwide cohorts

Abstract: Highlights Low physical activity and obesity predicted an excess risk of liver-related death. The excess risk conferred by obesity was markedly attenuated by physical activity. Overall, walking for >3 hours/week could have prevented 25% of liver-related deaths.

Cited by 40 publications

References 53 publications

Combined grip strength and calf circumference as a useful prognostic system in patients with liver diseases: a large cohort study

Combined grip strength and calf circumference as a useful prognostic system in patients with liver diseases: a large cohort study

Physical activity is associated with reduced risk of liver disease in the prospective UK Biobank cohort

Unhealthy lifestyle habits and physical inactivity among Asian patients with non‐alcoholic fatty liver disease

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