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Ohfuji S, Matsuura T, Tamori A, Kubo S, Sasaki S, Kondo K, Ito K, Fukushima W. Lifestyles Associated with Prognosis After Eradication of Hepatitis C Virus: A Prospective Cohort Study in Japan. Dig Dis Sci 2021; 66:2118-2128. [PMID: 32720018 DOI: 10.1007/s10620-020-06475-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular carcinoma develops in some patients with hepatitis C virus (HCV), even after achieving sustained virological response (SVR). AIMS We examined factors associated with liver disease progression in a prospective cohort study of SVR patients. METHODS Participants were patients who had visited a hospital for clinical follow-up of chronic HCV infection in 2005 and had reached SVR as a result of subsequent antiviral treatment. Baseline information including lifestyle and dietary habits before SVR was collected in 2005 using self-administered questionnaires, and clinical information before SVR was collected from medical records in 2005. Study outcome was liver disease progression such as liver cirrhosis, hepatocellular carcinoma, and/or liver disease-related death after SVR. Proportional hazard models were employed to calculate hazard ratios (HRs) and 95% confidence intervals for each variable. RESULTS Of 180 SVR patients, 27 patients (15%) showed liver disease progression after SVR: 26 (14%) were diagnosed with liver cirrhosis, two (1%) with hepatocellular carcinoma, and/or one (0.6%) with liver-disease-related death. Besides older age at SVR (HR = 11.9, P < 0.01) and aspartate aminotransferase-to-platelet ratio index score ≥ 1.0 before SVR (HR = 2.63, P = 0.03), alcohol drinkers before SVR (HR = 2.82, P = 0.06) were suggested to be associated with liver disease progression after SVR, whereas higher consumption of vitamin B12 before SVR showed a decreased HR for liver disease progression (HR = 0.41, P = 0.09). CONCLUSIONS Alcohol drinking might be associated with liver disease progression, whereas vitamin B12 intake might have protective effects against liver disease progression after eradication of HCV. Further studies are needed to confirm these findings.
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Affiliation(s)
- Satoko Ohfuji
- Department of Public Health, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan.
| | - Tomoka Matsuura
- Department of Public Health, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan
| | - Akihiro Tamori
- Department of Hepatology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kyoko Kondo
- Osaka City University Hospital, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, Japan
| | - Kazuya Ito
- College of Healthcare Management, 960-4, Takayanagi, Setaka-machi, Miyama-shi, Fukuoka, Japan
| | - Wakaba Fukushima
- Department of Public Health, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan
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Rocque B, Kahn J, Emamaullee J. A Healthy Liver After SVR: Food for Thought. Dig Dis Sci 2021; 66:1778-1779. [PMID: 32785795 PMCID: PMC7878581 DOI: 10.1007/s10620-020-06547-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Brittany Rocque
- Division of Abdominal Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Southern California, 1510 San Pablo Street, Suite 412, Los Angeles, CA, 90033, USA
| | - Jeffrey Kahn
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Juliet Emamaullee
- Division of Abdominal Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Southern California, 1510 San Pablo Street, Suite 412, Los Angeles, CA, 90033, USA.
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El Koofy N, Moawad EMI, Fahmy M, Mohamed MA, Mohamed HFA, Eid EM, Zaki ME, El-Sayed RM. Anthropometric, biochemical and clinical assessment of malnutrition among Egyptian children with chronic liver diseases: a single institutional cross-sectional study. BMC Gastroenterol 2019; 19:223. [PMID: 31864303 PMCID: PMC6925889 DOI: 10.1186/s12876-019-1145-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 12/17/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Malnutrition is a common problem among children with chronic liver diseases (CLD). We aimed to assess the nutritional status of children with CLD and to correlate the anthropometric indices with the severity of liver disease, liver function tests, insulin growth factor-1 (IGF-1) and 25-hydroxy vitamin D (25- OH D). METHODS A total of 69 patients with CLD and 50 healthy controls (6 months - 6 years) were included in the study. Nutritional status was assessed by anthropometric indices expressed in standard deviation score (Z score), biochemical, hematological and clinical parameters. RESULTS We found 52.2% of CLD patients underweight by weight for age (W/A); 50.2% were stunted by height for age/ length for age (HAZ or LAZ); and 39% exhibited wasting by weight/height or (length) for age (W/HZ or W/LZ) z scores analysis. The mean values of z scores for all anthropometric parameters were significantly correlated with unconjugated and conjugated bilirubin and INR (p < 0.05), except HAZ or LAZ. Also, a significant correlation to albumin was found, except for W/HZ or (W/LZ) (p = 0.157). The z scores < - 2 SD based on W/ H versus arm indicators showed significant differences in MUAC, UAA and AMA (p < 0.001). We found no correlation between anthropometric z-scores and the mean IGF-1 and (25- OH D) values (p > 0.05). Malnutrition was directly correlated with the severity of hepatic dysfunction, particularly, Child-Pugh C cases. The mean IGF-1 and (25- OH D) values were significantly correlated with the severity of liver disease (p < 0.001). CONCLUSIONS Our results identified anthropometric arm indicators and MUAC/A measurements as an effective applied methods for assessing nutritional status in CLD children. Moreover, Integrating comprehensive clinical assessment, anthropometric measurements and objective biochemical analyses is essential for evaluation, follow-up and management of CLD children with variable degree of malnutrition.
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Affiliation(s)
- Nehal El Koofy
- Department of Pediatrics, Faculty of Medicine, Cairo University, P.O.B. 126, Giza, Cairo, Egypt
| | | | - Mona Fahmy
- Academy of Scientific Research, Cairo, Egypt
| | | | | | - Ehab Mohamed Eid
- Institute of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
| | | | - Rokaya Mohamed El-Sayed
- Department of Pediatrics, Faculty of Medicine, Cairo University, P.O.B. 126, Giza, Cairo, Egypt
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Hand grip strength and adductor pollicis muscle thickness in patients on palliative care for hepatocellular carcinoma. CLINICAL NUTRITION EXPERIMENTAL 2018. [DOI: 10.1016/j.yclnex.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Chaudhry A, Toori KU, Shaikh JI. To determine correlation between biochemical parameters of nutritional status with disease severity in HCV related liver cirrhosis. Pak J Med Sci 2018; 34:154-158. [PMID: 29643898 PMCID: PMC5857003 DOI: 10.12669/pjms.341.14011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To identify correlation between biochemical parameters of nutritional status with disease severity in HCV related liver cirrhosis in patients attending tertiary care hospital. Methods Total 259 HCV related liver cirrhosis patients who attended the outpatient department of KRL Hospital, Islamabad from June 2016 to January 2018 were included in this cross-sectional study. HCV status was confirmed with PCR. Cirrhosis was pre-established by ultrasound, while cirrhosis severity was gauged by CTP score. Biochemical parameters for nutrition status included serum albumin, creatinine, cholesterol, LDL, HDL, triglycerides, hemoglobin, ferritin, sodium, potassium, magnesium and calcium. Other demographic and clinical data were also recorded. Results The mean age of patients was 58.73 ± 6.04 years with 57.1% being males. The average BMI was 22.72 ± 1.69 kg/m2. Majority patients i.e. 123 (47.5%) belonged to CTP-A, 67 (25.9%) were in CTP-B and 69 (26.6%) in CTP-C groups. Significant negative correlations of cirrhosis severity were established with BMI, albumin, creatinine, cholesterol, LDL, TG, HDL, hemoglobin, sodium and magnesium indicative of malnutrition. Analysis of biochemical parameters amongst individual cirrhosis groups revealed significant negative correlation across the same factors in group CTP-C, while CTP-A correlated positively with these parameters. The only significant correlation found in CTP-B was with albumin, HDL, hemoglobin, sodium and magnesium. Conclusion Considering limitations of standard ways alone to assess malnutrition in liver cirrhosis, biochemical parameters are valid to aid in diagnosing malnutrition.
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Affiliation(s)
- Asma Chaudhry
- Dr. Asma Chaudhry, MRCP (UK). Department of Medicine, KRL Hospital, Islamabad, Pakistan
| | - Kaleem Ullah Toori
- Dr. Kaleem Ullah Toori, FRCP (Glasgow). Department of Medicine, KRL Hospital, Islamabad, Pakistan
| | - Javaria Ilyas Shaikh
- Dr. Javaria Ilyas Shaikh, MBBS. Department of Medicine, KRL Hospital, Islamabad, Pakistan
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Fernandes SA, de Mattos AA, Tovo CV, Marroni CA. Nutritional evaluation in cirrhosis: Emphasis on the phase angle. World J Hepatol 2016; 8:1205-1211. [PMID: 27803765 PMCID: PMC5067440 DOI: 10.4254/wjh.v8.i29.1205] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/05/2016] [Accepted: 08/18/2016] [Indexed: 02/06/2023] Open
Abstract
Protein-calorie malnutrition (PCM) is a common condition in cirrhotic patients, leading to a worse prognosis, complications, poor quality of life and lower survival rates. Among ways of assessing nutritional status, there are anthropometric methods such as the evaluation of the triceps skinfold, the arm circumference, the arm muscle circumference and the body mass index, and non-anthropometric methods such as the subjective global assessment, the handgrip strength of non-dominant hand, and the bioelectrical impedance analysis (BIA). PCM is frequently under-diagnosed in clinical settings in patients with cirrhosis due to the limitations of nutritional evaluation methods in this population. BIA is a useful method, but cannot be indicated in patients with abnormal body composition. In these situations, the phase angle (PA) has been used, and can become an important tool in assessing nutritional status in any situation. The PA is superior to anthropometric methods and might be considered as a nutritional indicator in cirrhosis. The early characterization of the nutritional status in patients with cirrhosis means an early nutritional intervention, with a positive impact on patients’ overall prognosis. Among the usually accepted methods for nutritional diagnosis, the PA provides information in a quick and objective manner.
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Plasma Folate and Vitamin B12 Levels in Patients with Hepatocellular Carcinoma. Int J Mol Sci 2016; 17:ijms17071032. [PMID: 27376276 PMCID: PMC4964408 DOI: 10.3390/ijms17071032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 06/16/2016] [Accepted: 06/23/2016] [Indexed: 12/14/2022] Open
Abstract
Folate and vitamin B12 involved in the one-carbon metabolism may play a key role in carcinogenesis and progression of hepatocellular carcinoma (HCC) through influencing DNA integrity. The purpose of this study is to evaluate the association of plasma folate and vitamin B12 levels with HCC in a case-control study on 312 HCC patients and 325 cancer-free controls. Plasma concentrations of folate and vitamin B12 in all the subjects were measured by electrochemiluminescence immunoassay. Meanwhile, the information of HCC patients' clinical characteristics including tumor-node-metastasis (TNM) stage, tumor size and tumor markers were collected. The patients of HCC had significantly lower folate levels than those of controls; there was no significant difference in the mean of plasma vitamin B12 levels. We also observed an inverse association between the levels of plasma folate and HCC: the adjusted odds ratios (OR) (95% confidence intervals (CI)) of HCC from the highest to lowest quartile of folate were 0.30 (0.15-0.60), 0.33 (0.17-0.65), and 0.19 (0.09-0.38). Compared to the subjects in the lowest quartile of plasma vitamin B12, only the subjects in the highest quartile of vitamin B12 exhibited a significant positive relationship with HCC, the adjusted OR was 2.01 (95% CI, 1.02-3.98). HCC patients with Stage III and IV or bigger tumor size had lower folate and higher vitamin B12 levels. There was no significant difference in the mean plasma folate levels of the HCC cases in tumor markers status (AFP, CEA and CA19-9 levels), whereas patients with higher CEA or CA19-9 levels retained significantly more plasma vitamin B12 than those with normal-CEA or CA19-9 level. In conclusion, plasma folate and vitamin B12 levels could be associated with HCC, and might be used as predictors of clinical characteristics of HCC patients. However, further prospective studies are essential to confirm the observed results.
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