Analysis of the Physical Capacity of Patients with Non-Alcoholic Fatty Liver Disease
Abstract
Introduction: Non-alcoholic fatty liver disease (NAFLD) affects an average of 25% of the world population. Depending on the stage of the disease, metabolic changes and decline in physical capacity may occur. The aim of the study was to analyze and associate NAFLD stage with the physical capacity of patients. Methods: a cross-sectional observational study was carried out in patients from the Gastroenterology/Hepatology Service of the Santa Casa de Misericordia de Porto Alegre (ISCMPA) Brotherhood, who underwent liver biopsy and histopathological analysis according to Kleiner's classification. The patients reported self-reported data, performed the Six-Minute Walk Test (6MWT) and the Handgrip Strength Test (HGT) to assess their physical capacity. Statistical analysis used the Kolmogorov-Smirnov and Wilcoxon test to verify normality, the paired T test for the significance of observed vs. predicted 6MWT, Analysis of Variance (ANOVA) with Tukey's Post-Hoc test for histology, 6MWT and HGS, and Spearman's nonparametric test for correlations. Results: 54 patients of both genders diagnosed with NAFLD were analyzed. There was a correlation between the practice of physical exercises with the 6MWT (ρ .462; p<0.05) and with the HGT(ρ .391; p<0.05), and between fibrosis and dyslipidemia (ρ .466; p< 0.05). In the 6MWT, 49 patients failed to achieve the predicted 6MWT. Conclusion: The population with NAFLD was shown to have lower physical capacity than the estimate of a healthy population. No data were found that characterize a relationship between the 6MWT and the histological classification of the disease.
References
Anstee, QM, Lawitz, EJ, Alkhouri, N., Wong, VWS, Romero-Gomez, M., Okanoue, T., Trauner, M., Kersey, K., Li, G., Han, L., Jia, C., Wang, L., Chen, G., Subramanian, G. M., Myers, RP, Djedjos, CS, Kohli, A., Bzowej, N., Younes, Z., Sarin, S., Shiffman, ML, Harrison, SA, Afdhal, NH, Goodman, Z., e Younossi, ZM (2019). Noninvasive Tests Accurately Identify Advanced Fibrosis due to NASH: Baseline Data From the STELLAR Trials. Hepatology, 70(5), 1521-1530. https://doi.org/10.1002/hep.30842
Arab, JP, Barrera, F., Gallego, C., Valderas, JP, Uribe, S., Tejos, C., Serrano, C., Huete, Á., Liberona, J., Labbé, P., Quiroga, T., Benítez, C., Irarrázaval, P., Riquelme, A., e Arrese, M. (2016). High prevalence of undiagnosed liver cirrhosis and advanced fibrosis in type 2 diabetic patients. Annals of Hepatology, 15(5), 721-728. https://doi.org/10.5604/16652681.1212434
Arora, A., e Sharma, P. (2012). Non-invasive Diagnosis of Fibrosis in Non-alcoholic Fatty Liver Disease. Journal of Clinical and Experimental Hepatology, 2(2), 145-155. https://doi.org/10.1016/S0973-6883(12)60103-0
ATS (2002). American Thoracic Society ATS Statement : Guidelines for the Six-Minute Walk Test, 166, 111-117. https://doi.org/10.1164/rccm.166/1/111
Bacchi, E., Negri, C., Targher, G., Faccioli, N., Lanza, M., Zoppini, G., Zanolin, E., Schena, F., Bonora, E., e Moghetti, P. (2013). Both resistance training and aerobic training reduce hepatic fat content in type 2 diabetic subjects with nonalcoholic fatty liver disease (the RAED2 randomized trial). Hepatology, 58(4), 1287-1295. https://doi.org/10.1002/hep.26393
Benedetti, T.R.B., Antunes, P. de C., Rodriguez-Añez, C.R., Mazo, G.Z., e Petroski., É.L. (2007). Reprodutibilidade e validade do Questionário Internacional de Atividade Física (IPAQ) em homens idosos. Revista Brasileira de Medicina Do Esporte, 13(1), 11-16. https://doi.org/10.1590/s1517-86922007000100004
Berzigotti, A., Saran, U., e Dufour., J.F. (2016). Physical activity and liver diseases. Hepatology, 63(3), 1026-1040. https://doi.org/10.1002/hep.28132
Carey, EJ, Steidley, DE, Aqel, BA, Byrne, TJ, Mekeel, KL, Rakela, J., Vargas, HE, e Douglas, DD (2010). Six-minute walk distance predicts mortality in liver transplant candidates. Liver Transplantation, 16(12), 1373-1378. https://doi.org/10.1002/lt.22167
Castera, L. (2020). Non-invasive tests for liver fibrosis in NAFLD: Creating pathways between primary healthcare and liver clinics. Liver International : Official Journal of the International Association for the Study of the Liver, 40 Suppl 1(December 2019), 77-81. https://doi.org/10.1111/liv.14347
Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., Harrison, S. A., Brunt, EM, e Sanyal, AJ (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67(1), 328-357. https://doi.org/10.1002/hep.29367
Enomoto, H., Bando, Y., Nakamura, H., Nishiguchi, S., e Koga, M. (2015). Liver fibrosis markers of nonalcoholic steatohepatitis. World Journal of Gastroenterology, 21(24), 7427-7435. https://doi.org/10.3748/wjg.v21.i24.7427
Enright, P.L., e Sherrill., D.L. (1998). Reference equations for the six-minute walk in healthy adults. American Journal of Respiratory and Critical Care Medicine, 161(4 I), 1396. https://doi.org/10.1164/ajrccm.161.4.16147a
Foroncewicz, B., Mucha, K., Szparaga, B., Raczyńska, J., Ciszek, M., Pilecki, T., Krawczyk, M., e Pa̧czek, L. (2011). Rehabilitation and 6-minute walk test after liver transplantation. Transplantation Proceedings, 43(8), 3021-3024. https://doi.org/10.1016/j.transproceed.2011.08.007
Hamilton, G.F., McDonald, C., e Chenier, T.C. (1992). Measurement of grip strength: Validity and reliability of the sphygmomanometer and Jamar grip dynamometer. Journal of Orthopaedic and Sports Physical Therapy, 16(5), 215-219. https://doi.org/10.2519/jospt.1992.16.5.215
Kleiner, DE, Brunt, EM, Van Natta, M., Behling, C., Contos, MJ, Cummings, OW, Ferrell, LD, Liu, YC, Torbenson, MS, Unalp-Arida, A., Yeh, M., McCullough, AJ, e Sanyal, AJ (2005). Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology, 41(6), 1313-1321. https://doi.org/10.1002/hep.20701
Kwak, M.S., Kim., D., Kwak, M.S., e Kim, D. (2018). Non-alcoholic fatty liver disease and lifestyle modifications, focusing on physical activity. Korean Journal of Internal Medicine, 33(1), 64-74. https://doi.org/10.3904/kjim.2017.343
Leitão, A.V.A., Castro, C.L.N., Basile, T.M., Souza, T.H.S., e Braulio, V.B. (2003). Avaliação da capacidade física e do estado nutricional em candidatos ao transplante hepático. Revista da Associação Médica Brasileira, 49(4), 424-428. https://doi.org/10.1590/s0104-42302003000400035
Malachias, M., Souza, W., Plavnik, F., Rodrigues, C., Brandão, A., Neves, M., Bortolotto, L., Franco, R., Figueiredo, C., Jardim, P., Amodeo, C., Barbosa, E., Koch, V., Gomes, M., Paula, R., Póvoa, R., Colombo, F., Ferreira Filho, S., Miranda, R., Machado, CA, Nobre, F., Nogueira, AR, Mion Júnior, D., Kaiser, S., Forjaz, CLM, Almeida, FA, Martim, JFV, Sass, N., Drager, LF, Muxfeldt, E., Bodanese, LC, Feitosa, AD, Malta, D., Fuchs, S., Magalhães, ME, Oigman, W., Gomes, OM, Pierin, AMG, Feitosa, GS, Bortolotto, MRFL, Magalhães, LBNC, Silva, ACS, Ribeiro, JM, Borelli, FAO, Gus, M., Passarelli Júnior, O., Toledo, JY, Salles, GF, Martins, LC, Jardim, TSV, Guimarães, ICB, Antonello, IC, Lima Júnior, E., Matsudo, V., Silva, GV, Costa, LS, Alessi, A., Scala, LCN, Coelho, EB, Souza, D., Lopes, HF, Gowdak, MMG, Cordeiro Júnior, AC, Torloni, MR, Klein, MRST, Nogueira, PK, Lotaif, LAD, Rosito, GBA, e Moreno Júnior, H. (2016). Capítulo 1 - Conceituação, Epidemiologia e Prevenção Primária. Arquivos Brasileiros de Cardiologia, 107(3). https://doi.org/10.5935/abc.20160151
Marchesini, G., Day, CP, Dufour, JF, Canbay, A., Nobili, V., Ratziu, V., Tilg, H., Roden, M., Gastaldelli, A., Yki-Jarvinen, H., Schick, F., Vettor, R., Fruhbeck, G., e Mathus-Vliegen, L. (2016). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Journal of Hepatology, 64(6), 1388-1402. https://doi.org/10.1016/j.jhep.2015.11.004
Martin-Rodriguez, J.L., Gonzalez-Cantero, J., Gonzalez-Cantero, A., Arrebola, J.P., e Gonzalez-Calvin, J.L. (2017). Diagnostic accuracy of serum alanine aminotransferase as biomarker for nonalcoholic fatty liver disease and insulin resistance in healthy subjects, using 3T MR spectroscopy. Medicine (United States), 96(17). https://doi.org/10.1097/MD.0000000000006770
Merli, M., Berzigotti, A., Zelber-Sagi, S., Dasarathy, S., Montagnese, S., Genton, L., Plauth, M., e Parés, A. (2019). EASL Clinical Practice Guidelines on nutrition in chronic liver disease. Journal of Hepatology, 70(1), 172-193. https://doi.org/10.1016/j.jhep.2018.06.024
Miot, H.A. (2018). Análise de correlação em estudos clínicos e experimentais Correlation analysis in clinical and experimental studies. Jornal Vascular Brasileiro, 17(4), 275-279. https://doi.org/10.1590/1677-5449.174118
Newman, AB, Simonsick, EM, Naydeck, BL, Boudreau, RM, Kritchevsky, SB, Nevitt, MC, Pahor, M., Satterfield, S., Brach, JS, Studenski, SA, e Harris, TB (2006). Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. Journal of the American Medical Association, 295(17), 2018-2026. https://doi.org/10.1001/jama.295.17.2018
Pablo, A.J., Marco, A., e Michael, T. (2018). Recent Insights into the Pathogenesis of Nonalcoholic Fatty Liver Disease. Annual Review of Pathology: Mechanisms of Disease, 13(1), 321-350. https://doi.org/10.1146/annurev-pathol-020117-043617
Pereira, I.F. da S., Vale, D., Bezerra, M.S., Lima, K.C. de, Roncalli, A.G., e Lyra., C. de O. (2020). Padrões alimentares de idosos no Brasil: Pesquisa Nacional de Saúde, 2013. Ciencia e Saude Coletiva, 25(3), 1091-1102. https://doi.org/10.1590/1413-81232020253.01202018
Pereira, JLF, Figueredo, TCM, Galant, LH, Forgiarini, LA, Marroni, CA, Monteiro, MB, e Dias, AS (2011). Functional capacity and respiratory muscle strength of candidates to hepatic transplant. Revista Brasileira de Medicina Do Esporte, 17(5), 315-318. https://doi.org/10.1590/S1517-86922011000500004
Roberts, HC, Denison, HJ, Martin, HJ, Patel, HP, Syddall, H., Cooper, C., e Sayer, AA (2011). A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach. Age and Ageing, 40(4), 423-429. https://doi.org/10.1093/ageing/afr051
Shiratori, A.P., Iop, R. da R., Júnior, N.G.B., Domenech, S.C., e Gevaerd, M. da S. (2014). Protocolos de avaliação da força de preensão manual em indivíduos com artrite reumatoide: uma revisão sistemática. Revista Brasileira de Reumatologia, 54(2), 140-147. https://doi.org/10.1016/j.rbr.2014.03.009
Tandon, P., Ismond, K. P., Riess, K., Duarte-Rojo, A., Al-Judaibi, B., Dunn, MA, Holman, J., Howes, N., Haykowsky, MJF, Josbeno, DA, e McNeely, M. (2018). Exercise in cirrhosis: Translating evidence and experience to practice. Journal of Hepatology, 69(5), 1164-1177. https://doi.org/10.1016/j.jhep.2018.06.017
Vilar-Gomez, E., e Chalasani, N. (2017). Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers. Journal of Hepatology, 68(2), 305-315. https://doi.org/10.1016/j.jhep.2017.11.013
Yadav, A., Chang, YH, Carpenter, S., Silva, AC, Rakela, J., Aqel, BA, Byrne, TJ, Douglas, DD, Vargas, HE, e Carey, EJ (2015). Relationship between sarcopenia, six-minute walk distance and health-related quality of life in liver transplant candidates. Clinical Transplantation, 29(2), 134-141. https://doi.org/10.1111/ctr.12493
Copyright (c) 2021 Lecturas: Educación Física y Deportes
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
