Effect of non-alcoholic beer, diet and exercise on endothelial function, nutrition and quality of life in patients with cirrhosis

doi:10.4254/wjh.v12.i12.1299

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Clinical Trials Study

World J Hepatol. Dec 27, 2020; 12(12): 1299-1313
Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1299

Table 1 Baseline characteristics of the study population

	All (n = 43)	Control (n = 21)	Intervention (n = 22)	P value
Sex n (%) F/M	26 (60.5)/17 (39.5)	12 (46.2)/9 (52.9)	14 (53.8)/8 (47.1)	0.663
Age (yr)	53.5 ± 7.8	53.7 ± 8.2	53 ± 7.6	0.768
BMI (kg/m²)	29.5 ± 4.2	29.2 ± 3.7	29.8 ± 4.8	0.635
Etiology of cirrhosis
HCV n (%)	14 (32.6)	6 (28.5)	8 (36.4)	0.063
AIH n (%)	9 (20.9)	3 (14.3)	6 (27.3)
NAFLD n (%)	8 (18.6)	5 (23.8)	3 (13.6)
Others¹n (%)	12 (27.9)	7 (33.4)	5 (22.7)
History of complications [n (%)]
Variceal bleeding	2 (4.7)	2 (9.5)	0 (0)	0.233
Encephalopathy	1 (2.3)	0 (0)	1 (4.5)	0.500
Ascites	5 (11.6)	3 (14.3)	2 (9.1)	0.664
Child-Pugh stage
A	38 (88.4)	20 (95.2)	18 (81.9)	0.345
B	5 (11.6)	1 (4.8)	4 (18.1)	0.345
Child-Pugh	5 (5-6)	5 (5-6)	5 (5-6)	0.617
MELD score	8 (7-10)	8 (7.5-9.5)	8.5 (7-10)	0.524
Biochemical parameters
TB (mg/dL)	1.19 (0.82-1.95)	1.15 (0.75-1.44)	1.28 (0.85-2.11)	0.284
ALT (U/L)	43 (26-77)	43 (30-86.5)	43.1 (20.75-77)	0.882
AST (U/L)	48 (37-93)	47 (40-80)	50.5 (32-98)	0.881
AP (mg/dL)	142.2 ± 57.7	123.7 ± 44.1	159.8 ± 64.4	0.039
Albumin (g/dL)	4.0 (3.6-4.2)	4.1 (3.8-4.3)	3.9 (3.3-4.1)	0.170
Leukocytes (K/µL)	4.2 (3.7-5.3)	4.0 (3.7-5.15)	4.75 (3.725-5.925)	0.233
Platelets (K/µL)	80 (62-125)	77 (61.5-125)	93.5 (63.5-125)	0.520
Hemoglobin (g/dL)	14.1 ± 1.94	14.2 ± 3.3	14.0 ± 2.4	0.755
INR	1.1 (1.1-1.2)	1.1 (1.1-1.2)	1.1 (1.1-1.2)	0.870
Glucose (mg/dL)	91 (83-103)	94 (83.5-109)	91 (81-100.5)	0.882
Creatinine (mg/dL)	0.72 (0.63-0.80)	0.72 (0.60-0.81)	0.71 (0.64-0.79)	0.892
Sodium (mmol/L)	139 (137-141)	140 (137.5-141)	138 (137-140.2)	0.290
Potassium (mmol/L)	4.08 ± 0.32	4.0 ± 0.37	4.1 ± 0.25	0.198
CO2 (mmol/L)	24 (21-26)	23.0 (21.5-26)	24.5 (21-27.25)	0.518

¹Other etiologies included cryptogenic, primary biliary cholangitis and overlap syndrome (HAI/CBP). Data reported as mean ± standard deviation or median (p25-p75), according to the distribution of the data, or absolute frequency (percentage %). BMI: Body mass index; HCV: Hepatitis C virus; AIH: Autoimmune hepatitis; NAFLD: Non-alcoholic fatty liver disease; TB: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AP: Alkaline phosphatase; INR: International normalized ratio.

Table 2 Changes in clinical and biochemical parameters

	Control (n = 21)			Intervention (n = 22)
	Baseline	Final	P value	Baseline	Final	P value
Number of daily steps	8718 ± 2998	11391 ± 4298	0.000	8533 ± 4072	11142 ± 4055	0.000
PHES score	-1 ± 2.2	0 ± 2.2	0.130	-1 ± 2.1	0 ± 2.3	0.179
CFF (Hz)	43.9 ± 7.1	45.5 ± 5.8	0.238	44.5 ± 8.1	47.2 ± 6.4	0.174
TB (mg/dL)	1.15 (0.75-1.44)	1.12 (0.85-1.28)	0.985	1.28 (0.85-2.11)	1.13 (0.8-1.865)	0.068
ALT (U/L)	43 (30-86.5)	41 (23.5-71)	0.024	43.1 (20.75-77)	36 (20.25-67.5)	0.198
AST (U/L)	47 (40-80)	45 (29.5-53.5)	0.015	50.5 (32-98)	44 (28-75.75)	0.035
Alkaline phosphatase (U/L)	123.7 ± 44.1	105 (79.50-139)	0.408	159.8 ± 64.4	159.9 ± 79.3	0.988
Albumin (g/dL)	4.1 (3.8-4.3)	4 (3.75-4.2)	0.668	3.9 (3.3-4.1)	3.9 (3.475-4.3)	0.501
Leukocytes (K/µL)	4.0 (3.7-5.15)	3.9 (3-5)	0.984	4.75 (3.725-5.925)	4.9 (3.62-6.1)	0.515
Platelets (K/µL)	77 (61.5-125)	75 (59-106.5)	0.278	93.5 (63.5-125)	107 (78.5-150.25)	0.046
Hemoglobin (g/dL)	14.2 ± 3.3	14.17 ± 1.52	0.968	14.0 ± 2.4	14.25 ± 2	0.834
INR	1.1 (1.1-1.2)	1.1 (1.1-1.2)	0.414	1.1 (1.1-1.2)	1.1 (1.0-1.2)	0.166
Glucose (mg/dL)	94 (83.5-109)	88 (82-108)	0.145	91 (81-100.5)	87.5 (84.75-96.25)	0.615
Creatinine (mg/dL)	0.72 (0.60-0.81)	0.71 (0.6-0.84)	0.403	0.71 (0.64-0.79)	0.70 (0.62-0.79)	0.723
Na (mmol/L)	140 (137.5-141)	140 (139-141.5)	0.118	138 (137-140.2)	140 (138.5-141)	0.061
K (mmol/L)	4.0 ± 0.37	4.16 ± 0.38	0.195	4.1 ± 0.25	4.2 ± 0.37	0.078
CO₂ (mmol/L)	23.0 (21.5-26)	24.0 (22-26)	0.850	24.5 (21-27.25)	24 (22.95-26.15)	0.304

Data reported as mean ± standard deviation, or median (p25-p75), according to the distribution of the data. PHES: Psychometric hepatic encephalopathy score; CFF: Critical flicker frequency; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; INR: International normalized ratio.

Table 3 Endothelial function and hemodynamic variables

	Control (n = 21)		P value	Intervention (n = 22)		P value
	Baseline	Final		Baseline	Final
AUC	103.13 (92.55-107.15)	93.15 (86.53-99.61)	0.021	98.04 (92.17-102.35)	93.62 (85.06-99.60)	0.046
Systolic pressure (mmHg)	120 (110-130)	120 (120-129)	0.418	120 (110-120)	113 (110-120)	0.513
Diastolic pressure (mmHg)	80 (60-80)	80 (60-80)	0.862	70 (67.5-80)	70 (60-80)	0.385
Mean arterial pressure	90 (76.693.3)	93.3 (78.3-96)	0.729	86.6 (82.5-93.3)	83.3 (76.6-90.5)	0.385
Heart rate (bpm)	62 (60-72.7)	63 (60.25-80)	0.079	69 (61.5-75.2)	67 (61.5-71.25)	0.235

Data reported as median (p25-p75). AUC: Area under the curve.

Table 4 Changes in nutritional parameters at baseline and final evaluation

	Control (n = 21)		P value	Intervention (n = 22)		P value
	Baseline	Final		Baseline	Final
Phase angle	6.0 ± 0.7	5.9 ±0.6	0.427	5.8 ± 0.7	5.9 ± 0.7	0.198
MAMC (cm²)	24.1 ± 3.1	23.9 ± 3.5	0.462	23.5 ± 3.4	23.6 ± 3.9	0.783
TST (mm)	25.5 ± 7.9	24.7 ± 4.5	0.397	26.6 ± 6.7	26.9 ± 6.3	0.782
Thigh circumference (cm)	53.1 ± 6.5	52.9 ± 7.0	0.758	51.7 ± 6.4	53.1 ± 4.6	0.033
Handgrip strength (kg)	19.9 ± 11.5	21 ± 11.2	0.121	18.1 ± 10.3	19.9 ± 10.5	0.048
Sit-To-Stand test (s)	24.2 ± 4.4	20.9 ± 6.9	0.001	23.3 ± 3.9	21.0 ± 6.2	0.045

Data reported as mean ± standard deviation. MAMC: Mid-arm muscle circumference; TST: Triceps skinfold thickness.

Table 5 Changes in quality of life

	Control (n = 21)		P value	Intervention (n = 22)		P value
	Baseline	Final		Baseline	Final
CLDQ questionnaire
Abdominal symptoms	5.4 ± 1.3	5.2 ± 0.8	0.592	5.0 ± 1.5	5.1 ± 1.2	0.982
Fatigue	4.7 ± 1.1	5.2 ± 0.8	0.063	4.2 ± 1.2	5.1 ± 1.2	0.000
Systemic symptoms	5.6 ± 1.0	5.6 ± 0.9	0.892	4.3 ± 1.2	5.0 ± 0.9	0.002
Activity	5.3 ± 1.2	5.3 ± 1.3	0.892	4.8 ± 1.2	5.5 ± 1.2	0.028
Emotional function	4.9 ± 0.9	5.3 ± 1.1	0.056	4.3 ± 1.3	5.3 ± 1.0	0.000
Worry	5.1 ± 1.1	5.3 ± 1.1	0.521	4.3 ± 1.8	5.2 ± 1.8	0.002
CLDQ overall score	5.2 ± 0.8	5.4 ± 0.9	0.204	4.6 ± 1.0	5.3 ± 0.8	0.001
SF-36 questionnaire
Physical function	80 (70-90)	95 (80-95)	0.005	72.5 (65-95)	87.5 (70-95)	0.007
Physical role	75 (25-100)	100 (50-100)	0.166	62.5 (25 -100)	75 (25-100)	0.468
Body pain	84 (66-90)	84 (72-90)	0.341	78 (61-84)	78 (60-84)	0.725
General health	40 (37-47)	47 (35-52)	0.044	40 (25-55)	42 (32-52)	0.375
Vitality	65 (50-70)	70 (60-75)	0.453	62.5 (50-75)	70 (50-80)	0.037
Social function	100 (75-100)	88 (75-100)	0.875	75 (63-100)	88 (75-100)	0.080
Emotional role	67 (33-83)	67 (33-67)	0.972	67 (33-72)	67 (33-67)	0.752
Mental health	72 (68-84)	84 (64-88)	0.868	76 (64-84)	82 (68-92)	0.073

Data reported as mean ± standard deviation, or median (p25-p75), according to the distribution of the data. CLDQ: Chronic liver disease questionnaire; SF-36: 36-item short form health survey.

Citation: Macías-Rodríguez RU, Ruiz-Margáin A, Román-Calleja BM, Espin-Nasser ME, Flores-García NC, Torre A, Galicia-Hernández G, Rios-Torres SL, Fernández-del-Rivero G, Orea-Tejeda A, Lozano-Cruz OA. Effect of non-alcoholic beer, diet and exercise on endothelial function, nutrition and quality of life in patients with cirrhosis. World J Hepatol 2020; 12(12): 1299-1313
URL: https://www.wjgnet.com/1948-5182/full/v12/i12/1299.htm
DOI: https://dx.doi.org/10.4254/wjh.v12.i12.1299