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Multiple Factors Predict Physical Performance in People with Chronic Liver Disease

Loria, Anthony BS; Doyle, Katherine MS; Weinstein, Ali A. PhD; Winter, Patrice MS; Escheik, Carey BS; Price, Jillian MS; Wang, Lei MS; Birerdinc, Aybike PhD; Baranova, Ancha PhD; Gerber, Lynn MD; Younossi, Zobair M. MD, MPH

American Journal of Physical Medicine & Rehabilitation: June 2014 - Volume 93 - Issue 6 - p 470–476
doi: 10.1097/PHM.0000000000000050
Original Research Articles

Objective The aim of this study was to assess whether physical performance correlates with metabolic and inflammatory measures in research subjects with chronic liver disease.

Design This is a prospective, descriptive cohort study correlating performance on a 6-min walk test with cardiorespiratory variables, metabolic measures (glucose [GLU], C-peptide insulin, and lipids), liver enzymes (aspartate aminotransferase and alanine aminotransferase), and the proinflammatory cytokine interleukin-8 (IL-8).

Results This study enrolled 51 subjects (18 women) with chronic liver disease: 41% (n = 21) with nonalcoholic fatty liver disease and 59% (n = 30) with hepatitis C virus. Age, resting heart rate, and fasting GLU correlated significantly with distance walked (P’s < 0.05). First quartile “poor performers” (n = 14) and fourth quartile “high performers” (n = 14) showed differences in age, sex, fasting GLU, and IL-8 level (P’s < 0.05). Combining the number of abnormal serum values (IL-8, C-peptide insulin, GLU, aspartate aminotransferase, alanine aminotransferase, high-density lipoprotein, triglyceride, and total cholesterol) did not correlate with distance walked (P > 0.90). However, in multiple regression analysis, a model that included sex, age, resting heart rate, IL-8 level, and fasting GLU level explained approximately 39% of the variance in the distance walked during the test.

Conclusions Older age, female sex, abnormal levels of the proinflammatory cytokine IL-8, abnormalities of GLU metabolism, and high resting heart rate are associated with poor physical performance in subjects with chronic liver disease. Poor physical performance is associated with physiologic, metabolic, and inflammatory abnormalities in subjects with nonalcoholic fatty liver disease and hepatitis C virus.

From the Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia (AL, KD, PW, CE, JP, A. Birerdinc, A. Baranova, LG, ZMY); Center for the Study of Chronic Illness and Disability (AAW, PW, JP, LG) and Center for the Study of Genomics in Liver Diseases, School of Systems Biology (KD, LW, A. Birerdinc, A. Baranova, ZMY), George Mason University, Fairfax, Virginia; and Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia (CE, LG, ZMY).

All correspondence and requests for reprints should be addressed to: Zobair M. Younossi, MD, MPH, Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research Building, 3300 Gallows Rd, Falls Church, VA 22042.

Supported in part by the Beatty Liver and Obesity Research Fund and Liver Disease Outcomes Fund, Inova Health System, Falls Church, VA.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2014 by Lippincott Williams & Wilkins