J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 12, December 2018, pages 920-927

Relationship Between Sarcopenia and Both Physical Activity and Lifestyle in Patients With Chronic Liver Disease

Figure 1. ROC analysis. (a) age; (b) body mass index; (c) physical activity; (d) total time of sitting and lying on the day. AUC: area under the curve; CI: confidence interval; BMI: body mass index.

**Table 1.** Comparison of the Two Groups With and Without Sarcopenia
	All patients (n = 214)	Sarcopenia (n = 27)	Non-sarcopenia (n = 187)	P value
Data were expressed as means ± standard deviation or as median (interquartile range) or as n (%). P < 0.05 was considered significant. Categorical variables were compared by Fisher’s exact test and continuous variables were compared by Student’s t-tests or Mann-Whitney U test. BMI, body mass index.
Age (years)	68.17 ± 11.17	76.48 ± 6.69	66.97 ± 11.19	< 0.01
Sex, male (%)	122 (57%)	13 (48.1%)	109 (58.3%)	0.41
BMI (kg/m²)	23.4 ± 3.7	20.8 ± 2.4	23.8 ± 3.7	< 0.01
Etiology of liver disease (%)				< 0.01
Hepatitis B	54 (25.2%)	1 (3.7%)	54 (29%)
Hepatitis C	78 (36.4%)	12 (44.4%)	68 (36%)
Alcoholic hepatitis	25 (11.7%)	6 (22.2%)	19 (10.2%)
Non-alcoholic steatohepatitis	28 (13.1%)	2 (7.4%)	26 (13.9%)
Autoimmune hepatitis	1 (0.5%)	0	1 (0.5%)
Primary biliary cirrhosis	6 (2.8%)	0	6 (3.2%)
Others	22 (10.3%)	6 (22.2%)	16 (8.6%)
Hepatocellular carcinoma, yes (%)	55 (25.7%)	10 (37%)	45 (24.1%)	0.16
ALBI-grade (%)				0.03
1	168 (78.5%)	16 (64%)	152 (81.3%)
2	45 (21%)	9 (36%)	34 (18.2%)
3	1 (0.5%)	0	1 (0.5%)
Branched chain amino acids, yes (%)	84 (39.3%)	15 (60%)	72 (38%)	0.09
Physical activity (METs-h/week)	15.55 (6.6 - 34.46)	6.6 (2.34 - 19.90)	16.50 (6.6 - 41.23)	< 0.01
Total time sitting and lying (h/day)	5.90 ± 3.34	7.43 ± 4.09	5.68 ± 3.17	0.01
Living alone, yes (%)	40 (18.7%)	7 (25.9%)	33 (17.6%)	0.29
Currently smoking, yes (%)	35 (16.4%)	1 (3.7%)	34 (18.2%)	0.09
Currently drinking, yes (%)	43 (20.1%)	5 (18.5%)	38 (20.3%)	> 0.99
Driving of cars (%)	172 (80.4%)	17 (63.0%)	155 (82.9%)	0.02
Employment status, retired (%)	112 (52.3%)	22 (81.5%)	90 (48.1%)	< 0.01
Do home tasks, yes (%)	121 (56.5%)	20 (74.1%)	101 (54%)	0.06
Healthy eating, yes (%)	185 (86.4%)	25 (92.6%)	160 (85.6%)	0.54
Exercise habits, yes (%)	151 (70.6%)	19 (70.4%)	132 (70.6%)	> 0.99

Table 1. Comparison of the Two Groups With and Without Sarcopenia

All patients (n = 214)

Sarcopenia (n = 27)

Non-sarcopenia (n = 187)

P value

Data were expressed as means ± standard deviation or as median (interquartile range) or as n (%). P < 0.05 was considered significant. Categorical variables were compared by Fisher’s exact test and continuous variables were compared by Student’s t-tests or Mann-Whitney U test. BMI, body mass index.

Age (years)

68.17 ± 11.17

76.48 ± 6.69

66.97 ± 11.19

< 0.01

Sex, male (%)

122 (57%)

13 (48.1%)

109 (58.3%)

0.41

BMI (kg/m²)

23.4 ± 3.7

20.8 ± 2.4

23.8 ± 3.7

< 0.01

Etiology of liver disease (%)

< 0.01

Hepatitis B

54 (25.2%)

1 (3.7%)

54 (29%)

Hepatitis C

78 (36.4%)

12 (44.4%)

68 (36%)

Alcoholic hepatitis

25 (11.7%)

6 (22.2%)

19 (10.2%)

Non-alcoholic steatohepatitis

28 (13.1%)

2 (7.4%)

26 (13.9%)

Autoimmune hepatitis

1 (0.5%)

Primary biliary cirrhosis

6 (2.8%)

6 (3.2%)

Others

22 (10.3%)

6 (22.2%)

16 (8.6%)

Hepatocellular carcinoma, yes (%)

55 (25.7%)

10 (37%)

45 (24.1%)

0.16

ALBI-grade (%)

0.03

168 (78.5%)

16 (64%)

152 (81.3%)

45 (21%)

9 (36%)

34 (18.2%)

1 (0.5%)

Branched chain amino acids, yes (%)

84 (39.3%)

15 (60%)

72 (38%)

0.09

Physical activity (METs-h/week)

15.55 (6.6 - 34.46)

6.6 (2.34 - 19.90)

16.50 (6.6 - 41.23)

< 0.01

Total time sitting and lying (h/day)

5.90 ± 3.34

7.43 ± 4.09

5.68 ± 3.17

0.01

Living alone, yes (%)

40 (18.7%)

7 (25.9%)

33 (17.6%)

0.29

Currently smoking, yes (%)

35 (16.4%)

1 (3.7%)

34 (18.2%)

0.09

Currently drinking, yes (%)

43 (20.1%)

5 (18.5%)

38 (20.3%)

> 0.99

Driving of cars (%)

172 (80.4%)

17 (63.0%)

155 (82.9%)

0.02

Employment status, retired (%)

112 (52.3%)

22 (81.5%)

90 (48.1%)

< 0.01

Do home tasks, yes (%)

121 (56.5%)

20 (74.1%)

101 (54%)

0.06

Healthy eating, yes (%)

185 (86.4%)

25 (92.6%)

160 (85.6%)

0.54

Exercise habits, yes (%)

151 (70.6%)

19 (70.4%)

132 (70.6%)

> 0.99

**Table 2.** Comparison of Biochemical Measurements
Variable	Sarcopenia (n = 27)	Non-sarcopenia (n = 187)	P value
Data were expressed as median (interquartile range) or as n (%). P < 0.05 was considered significant. Categorical variables were compared by Fisher’s exact test and continuous variables were compared by Mann-Whitney U test. Alb: serum albumin; ALP: alkaline phosphatase; ALT: alanine transaminase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; CK: creatine kinase; Cre: creatinine; ChE: cholinesterase; eGFR: estimated glomerular filtration rate; Hb: hemoglobin; HbA1c: hemogobinA1c; AFP: α-fetoprotein; K: potassium; Na: sodium; PT-INR: prothrombin time-international normalized ratio; T-bil: total bilirubin; T-cho: total cholesterol; TP: total protein; TG: triglyceride; RBC: red blood cell count; WBC: white blood cell count; TLC: total lymphocyte count; Plt: platelet count; CONUT-score: controlling nutritional status index score; Fib4-index: fibrosis 4 index.
Alb (g/dL)	3.9 (3.4 - 4.3)	4.2 (4.0 - 4.45)	< 0.01
ALP (U/L)	254.0 (197.5 - 353.5)	245.0 (197.0 - 323.8)	0.68
ALT (U/L)	13.0 (10.5 - 18.0)	18.0 (14.0 - 26.0)	0.01
AST (U/L)	23.0 (18.5 - 36.0)	26.0 (22.0 - 32.0)	0.38
BUN (mg/dL)	17.2 (13.4 - 22.1)	15.1 (13.0 - 17.3)	0.05
CK (U/L)	88.0 (59.0 - 109.50)	102.5 (77.0 - 159.5)	0.01
Cre (mg/dL)	0.72 (0.51 - 0.92)	0.72 (0.59 - 0.82)	0.92
ChE (U/L)	228.0 (173.0 - 301.5)	289.5 (244.0 - 356.8)	< 0.01
eGFR (mL/m/1.73 m²)	68.8 (59.0 - 87.1)	74.8 (66.3 - 86.6)	0.23
Hb (g/dL)	12.4 (11.2 - 13.4)	13.5 (12.6 - 14.7)	< 0.01
HbA1c (%)	5.8 (5.4 - 6.3)	5.80 (5.5 - 6.2)	0.79
AFP (ng/mL)	3.30 (2.3 - 4.3)	3.10 (2.1 - 4.7)	0.62
K (mmol)	4.1 (3.9 - 4.4)	4.09 (4.0 - 4.3)	0.56
Na (mmol)	141.0 (138.5 - 142.0)	140.00 (139.00 - 142.00)	0.49
PT-INR	1.02 (0.97 - 1.05)	1.00 (0.97 - 1.05)	0.87
T-bil (mg/dL)	0.52 (0.42 - 0.71)	0.65 (0.49 - 0.80)	0.02
T-cho (mg/dL)	181.0 (167.5 - 203.0)	174.0 (157.5 - 199.0)	0.26
TP (g/dL)	7.5 (6.9 - 7.7)	7.4 (7.1 - 7.7)	0.94
TG (mg/dL)	102.0 (76.5 - 141.5)	90.5 (65.0 - 130.5)	0.36
RBC (× 10⁴/µL)	400.0 (371.5 - 437.5)	437.0 (405.0 - 477.5)	< 0.01
WBC (× 10²/µL)	54.0 (40.0 - 64.0)	53.0 (42.0 - 64. 0)	0.67
TLC	1,361.1 (930.6 - 1,626.1)	1,522.80 (1,160.8 - 2,136.70)	< 0.01
Plt (× 10⁴)	18.10 (11.7 - 21.3)	19.30 (15.9 - 24.2)	0.11
CONUT-score	2.0 (1.5 - 4.0)	1.0 (1.0 - 2.5)	0.02
CONUT-grade			0.01
Normal	7 (25.9%)	99 (52.9%)
Light	16 (59.3%)	80 (42.8%)
Moderate	4 (14.8%)	7 (3.7%)
Severe malnutrition	0 (0%)	1 (0.5%)
Fib4-index	2.7 (2.0 - 4.9)	2.1 (1.6 - 3.0)	< 0.01

Table 2. Comparison of Biochemical Measurements

Variable

Sarcopenia (n = 27)

Non-sarcopenia (n = 187)

P value

Data were expressed as median (interquartile range) or as n (%). P < 0.05 was considered significant. Categorical variables were compared by Fisher’s exact test and continuous variables were compared by Mann-Whitney U test. Alb: serum albumin; ALP: alkaline phosphatase; ALT: alanine transaminase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; CK: creatine kinase; Cre: creatinine; ChE: cholinesterase; eGFR: estimated glomerular filtration rate; Hb: hemoglobin; HbA1c: hemogobinA1c; AFP: α-fetoprotein; K: potassium; Na: sodium; PT-INR: prothrombin time-international normalized ratio; T-bil: total bilirubin; T-cho: total cholesterol; TP: total protein; TG: triglyceride; RBC: red blood cell count; WBC: white blood cell count; TLC: total lymphocyte count; Plt: platelet count; CONUT-score: controlling nutritional status index score; Fib4-index: fibrosis 4 index.

Alb (g/dL)

3.9 (3.4 - 4.3)

4.2 (4.0 - 4.45)

< 0.01

ALP (U/L)

254.0 (197.5 - 353.5)

245.0 (197.0 - 323.8)

0.68

ALT (U/L)

13.0 (10.5 - 18.0)

18.0 (14.0 - 26.0)

0.01

AST (U/L)

23.0 (18.5 - 36.0)

26.0 (22.0 - 32.0)

0.38

BUN (mg/dL)

17.2 (13.4 - 22.1)

15.1 (13.0 - 17.3)

0.05

CK (U/L)

88.0 (59.0 - 109.50)

102.5 (77.0 - 159.5)

0.01

Cre (mg/dL)

0.72 (0.51 - 0.92)

0.72 (0.59 - 0.82)

0.92

ChE (U/L)

228.0 (173.0 - 301.5)

289.5 (244.0 - 356.8)

< 0.01

eGFR (mL/m/1.73 m²)

68.8 (59.0 - 87.1)

74.8 (66.3 - 86.6)

0.23

Hb (g/dL)

12.4 (11.2 - 13.4)

13.5 (12.6 - 14.7)

< 0.01

HbA1c (%)

5.8 (5.4 - 6.3)

5.80 (5.5 - 6.2)

0.79

AFP (ng/mL)

3.30 (2.3 - 4.3)

3.10 (2.1 - 4.7)

0.62

K (mmol)

4.1 (3.9 - 4.4)

4.09 (4.0 - 4.3)

0.56

Na (mmol)

141.0 (138.5 - 142.0)

140.00 (139.00 - 142.00)

0.49

PT-INR

1.02 (0.97 - 1.05)

1.00 (0.97 - 1.05)

0.87

T-bil (mg/dL)

0.52 (0.42 - 0.71)

0.65 (0.49 - 0.80)

0.02

T-cho (mg/dL)

181.0 (167.5 - 203.0)

174.0 (157.5 - 199.0)

0.26

TP (g/dL)

7.5 (6.9 - 7.7)

7.4 (7.1 - 7.7)

0.94

TG (mg/dL)

102.0 (76.5 - 141.5)

90.5 (65.0 - 130.5)

0.36

RBC (× 10⁴/µL)

400.0 (371.5 - 437.5)

437.0 (405.0 - 477.5)

< 0.01

WBC (× 10²/µL)

54.0 (40.0 - 64.0)

53.0 (42.0 - 64. 0)

0.67

TLC

1,361.1 (930.6 - 1,626.1)

1,522.80 (1,160.8 - 2,136.70)

< 0.01

Plt (× 10⁴)

18.10 (11.7 - 21.3)

19.30 (15.9 - 24.2)

0.11

CONUT-score

2.0 (1.5 - 4.0)

1.0 (1.0 - 2.5)

0.02

CONUT-grade

0.01

Normal

7 (25.9%)

99 (52.9%)

Light

16 (59.3%)

80 (42.8%)

Moderate

4 (14.8%)

7 (3.7%)

Severe malnutrition

0 (0%)

1 (0.5%)

Fib4-index

2.7 (2.0 - 4.9)

2.1 (1.6 - 3.0)

< 0.01

**Table 3.** Logistic Regression Analysis of Variables Associated With Sarcopenia
Variable	Univariate analysis	Multivariate analysis
Data were analyzed by logistic regression analysis model. OR: odds ratio; CI: confidence interval; BMI: body mass index.
Age (≥ 71/< 71 years)	5.42	2.00 - 17.22	< 0.01	5.89	2.15 - 16.20	< 0.01
Employment status (retired/employed)	4.22	1.52 - 11.70	< 0.01
BMI (< 22.2/≥ 22.2)	3.91	1.56 - 1048	< 0.01	4.77	1.87 - 12.10	< 0.01
Low frequency of driving (yes/no)	2.83	1.06 - 7.28	0.02
Physical activity (< 10.2/≥ 10.2)	3.40	1.38 - 8.85.	< 0.01	3.65	2.15 - 16.20	< 0.01
Total time sitting and lying (≥ 8/< 8)	2.67	1.07 - 6.63	0.02

Table 3. Logistic Regression Analysis of Variables Associated With Sarcopenia

Variable

Univariate analysis

Multivariate analysis

95% CI

P value

95% CI

P value

Data were analyzed by logistic regression analysis model. OR: odds ratio; CI: confidence interval; BMI: body mass index.

Age (≥ 71/< 71 years)

5.42

2.00 - 17.22

< 0.01

5.89

2.15 - 16.20

< 0.01

Employment status (retired/employed)

4.22

1.52 - 11.70

< 0.01

BMI (< 22.2/≥ 22.2)

3.91

1.56 - 1048

< 0.01

4.77

1.87 - 12.10

< 0.01

Low frequency of driving (yes/no)

2.83

1.06 - 7.28

0.02

Physical activity (< 10.2/≥ 10.2)

3.40

1.38 - 8.85.

< 0.01

3.65

2.15 - 16.20

< 0.01

Total time sitting and lying (≥ 8/< 8)

2.67

1.07 - 6.63

0.02