Asada F1, Nomura T2, Kubota M1, Hosui A3
1Osaka Rosai Hospital, Research Center for the Promotion of Health and Employment Support, Sakai City, Osaka, Japan, 2Kansai University of Welfare Sciences, Department of Rehabilitation Sciences, Kashiwara-City, Osaka, Japan, 3Osaka Rosai Hospital, Department of Gastroenterology and Hepatology, Sakai City, Osaka, Japan
Background: Previous studies have demonstrated that exercise therapy can improve fatty change of the liver in patients with nonalcoholic fatty liver disease (van der Heijden GJ, 2010; Johnson NA, 2009). Additionally, guidance on diet and aerobic exercise reduces body weight, thereby improving liver histology in patients with nonalcoholic steatohepatitis (NASH) (Promrat K, 2010; Vilar Gomez E, 2009). However, few studies have focused on the effect of physical activity on hepatic fibrosis in this clinical population.
Purpose: This study aimed to investigate the association between hepatic fibrosis and physical activity in NASH patients.
Methods: Participants included 35 outpatients (14 men, 21 women; mean age, 63 ± 9 years [range, 40-79 years]) at the Department of Gastroenterology, Osaka Rosai Hospital, who were diagnosed with NASH and received guidance on physical activity at the Research Center for the Promotion of Heath and Employment Support in the hospital. After obtaining informed consent from all participants, blood samples were collected for biochemical analysis. The FIB-4 index (based on age, aspartate and alanine aminotransferase and platelet counts) with a cutoff value of 2.67 was used as a marker for hepatic fibrosis (Shah AG, 2009); participants were divided into a hepatic fibrosis group (≥2.67) and a control group ( 2.67). Physical activity over the previous week (MET hours/week) was assessed by a single investigator via an interview. Univariate and multivariate analyses were performed to assess the association of hepatic fibrosis with explanatory variables. Statistical analysis was performed using IBM SPSS Statistics 24, and a P value of 0.05 was considered significant.
This study was approved by the ethics committee of Osaka Rosai Hospital.
Results: The mean age, body mass index (BMI), and skeletal muscle mass and body fat amount, as measured by bioelectrical impedance analysis, in the hepatic fibrosis group (6 men, 10 women) were 66 ± 8 years, 24 ± 4 kg/m2, 22 ± 5 kg, and 21 ± 8 kg, respectively, and the corresponding values in the control group (8 men, 11 women) were 60 ± 9 years, 26 ± 4 kg/m2, 23 ± 4 kg, and 23 ± 7 kg, respectively. Thus, there were no significant differences between the groups. Physical activity was lower in the hepatic fibrosis group (7.6 ± 5.4 Ex) than in the control group (8.5 ± 6.7 Ex), but the difference was not statistically significant. Logistic regression analysis using the FIB-4 index as the objective variable (control group, 1; hepatic fibrosis group, 2) showed that physical activity (odds ratio, 0.847; 95% confidence interval, 0.729-0.984), age, and sex were significant explanatory factors (other explanatory variables included BMI, skeletal muscle mass, and body fat amount).
Conclusion(s): Physical activity may suppress the progression of hepatic fibrosis in NASH patients. Therefore, NASH patients who have no restrictions on exercise should be encouraged to increase physical activity.
Implications: Physical therapists should inform NASH patients that an increase in physical activity contributes to the prevention and improvement of hepatic fibrosis.
Keywords: Nonalcoholic steatohepatitis, physical activity, FIB-4
Funding acknowledgements:
This research grant by the Japan Organization of Occupational Health and Safety
Purpose: This study aimed to investigate the association between hepatic fibrosis and physical activity in NASH patients.
Methods: Participants included 35 outpatients (14 men, 21 women; mean age, 63 ± 9 years [range, 40-79 years]) at the Department of Gastroenterology, Osaka Rosai Hospital, who were diagnosed with NASH and received guidance on physical activity at the Research Center for the Promotion of Heath and Employment Support in the hospital. After obtaining informed consent from all participants, blood samples were collected for biochemical analysis. The FIB-4 index (based on age, aspartate and alanine aminotransferase and platelet counts) with a cutoff value of 2.67 was used as a marker for hepatic fibrosis (Shah AG, 2009); participants were divided into a hepatic fibrosis group (≥2.67) and a control group ( 2.67). Physical activity over the previous week (MET hours/week) was assessed by a single investigator via an interview. Univariate and multivariate analyses were performed to assess the association of hepatic fibrosis with explanatory variables. Statistical analysis was performed using IBM SPSS Statistics 24, and a P value of 0.05 was considered significant.
This study was approved by the ethics committee of Osaka Rosai Hospital.
Results: The mean age, body mass index (BMI), and skeletal muscle mass and body fat amount, as measured by bioelectrical impedance analysis, in the hepatic fibrosis group (6 men, 10 women) were 66 ± 8 years, 24 ± 4 kg/m2, 22 ± 5 kg, and 21 ± 8 kg, respectively, and the corresponding values in the control group (8 men, 11 women) were 60 ± 9 years, 26 ± 4 kg/m2, 23 ± 4 kg, and 23 ± 7 kg, respectively. Thus, there were no significant differences between the groups. Physical activity was lower in the hepatic fibrosis group (7.6 ± 5.4 Ex) than in the control group (8.5 ± 6.7 Ex), but the difference was not statistically significant. Logistic regression analysis using the FIB-4 index as the objective variable (control group, 1; hepatic fibrosis group, 2) showed that physical activity (odds ratio, 0.847; 95% confidence interval, 0.729-0.984), age, and sex were significant explanatory factors (other explanatory variables included BMI, skeletal muscle mass, and body fat amount).
Conclusion(s): Physical activity may suppress the progression of hepatic fibrosis in NASH patients. Therefore, NASH patients who have no restrictions on exercise should be encouraged to increase physical activity.
Implications: Physical therapists should inform NASH patients that an increase in physical activity contributes to the prevention and improvement of hepatic fibrosis.
Keywords: Nonalcoholic steatohepatitis, physical activity, FIB-4
Funding acknowledgements:
This research grant by the Japan Organization of Occupational Health and Safety
Topic: Non-communicable diseases (NCDs) & risk factors; Occupational health & ergonomics; Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: Osaka Rosai Hospital
Ethics committee: Osaka Rosai Hospital Ethics Committee
Ethics number: 20130215-11
All authors, affiliations and abstracts have been published as submitted.
