Exercise Might Prevent Cirrhosis in Overweight and Obese Adults

Cheng-Feng Jan; Oswald Ndi Nfor; Jing-Yang Huang; Shu-Yi Hsu; Pei-Chieh Ko; Min-Chen Wu; Chien-Chang Ho; Yung-Po Liaw

Disclosures

Liver International. 2018;38(3):515-522. 

In This Article

Abstract and Introduction

Abstract

Background & Aims Exercise in overweight patients with liver disease has improved liver enzymes, insulin levels and quality of life. Scientific evidence is incomplete regarding the role of exercise in the prevention of cirrhosis. We investigated the effect of exercise on the occurrence of cirrhosis in obese and overweight adults.

Methods Exercise was assessed using the 2012 Adult Preventive Medical Service dataset while cirrhosis was identified using the National Health Insurance Research Database. All participants were aged 40 years and older. Unconditional logistic regression was used to estimate the odds ratios for cirrhosis.

Results Overall, 1586 overweight and 1525 obese adults were identified with cirrhosis. Weekly exercise >150 min was significantly protective for cirrhosis in obese men and women. However, exercise <150 min/wk was significantly protective only in men compared to women. For weekly exercise >150 mins, the odds ratio for cirrhosis in obese men and women was 0.701 (95% CI: 0.584–0.841) and 0.736 (95% CI: 0.562–0.964) respectively. The adjusted odds ratios in overweight men and women were 0.734 (95% CI: 0.622–0.866) and 0.503 (CI: 0.37–0.684). For weekly exercise <150 min/wk, overweight and obese men had odds ratios of 0.879 (CI: 0.0.788–0.98) and 0.874 (CI: 0.782–0.977) compared to 0.918 (95% CI: 0.778–1.083) and 0.916 (95% CI: 0.780–1.075) in overweight and obese women respectively.

Conclusions Moderate exercise might significantly prevent obese and overweight adults from developing cirrhosis. The benefits appear to be greater for persons who exceed the minimum recommendations of 150 min/wk.

Introduction

Cirrhosis is increasingly becoming a serious threat to global health.[1,2] It results from different mechanisms of liver injury that lead to necroinflammation and fibrogenesis.[2] Common risk factors in developed countries include alcoholic liver disease and hepatitis C, whereas hepatitis B is the major risk factor particularly in Africa and Asia.[3] The proportion of individuals with cirrhosis is projected to reach 37.2% in 2020, and 44.9% in 2030.[4] In addition, the economic burden associated with the disease is overwhelming.[5] Liver transplant remains the only cure for the disease. Preventing the need for liver transplantation in patients with cirrhosis is the greatest challenge in the 21st century.[2]

Physical activity has been suggested to have survival benefits among individuals with liver disease. Exercise has improved liver enzymes, serum insulin levels and quality of life in overweight patients with liver disease.[6] In addition, moderate-to-vigorous physical ≥250 min/wk as part of lifestyle management is believed to improve non-alcoholic fatty liver disease (NAFLD) pathophysiology in men through reducing inflammation and oxidative stress levels and altering fatty acid metabolism.[7] Improvement in exercise capacity and muscle strength have been reported after physical training in patients with cirrhosis.[8] The relationship between physical activity and chronic liver diseases is poorly understood. Furthermore, studies to investigate the impact of physical activity on cirrhosis and other liver diseases are relatively recent.[9,10]

Increasing sedentary behaviour is becoming a growing problem in populations.[11] Sedentary behaviour is reported to be higher in people predisposed to metabolic syndrome, excessive adiposity, and Type 2 DM. Increases in sedentary time could play a potential role in the development of NAFLD independent of exercise.[11] According to the 2015 Hepatitis C Support Project, NAFLD is expected to be the leading cause of cirrhosis in the coming decades.

Liver transplantation remains the only curative option for a selected group of patients with cirrhosis.[3] However, it is beneficial only to a small number of individuals because of its high expense. Alternative measures for both the prevention and treatment of cirrhosis and other liver diseases are vitally essential. As mentioned earlier, regular physical activity has prevented the onset and progression of numerous chronic diseases. Nonetheless, the role of exercise in the prevention of cirrhosis has not been widely discussed in previous publications. The aim of this study was to investigate the links between exercise and cirrhosis in obese and overweight adults.

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