Advertisement

The unhealthy lifestyle in primary biliary cholangitis: An enemy to fight

Published:December 31, 2022DOI:https://doi.org/10.1016/j.dld.2022.12.009

      Abstract

      Background and aim

      Metabolic dysfunctions, particularly hyperlipidemia, are a common finding in Primary Biliary Cholangitis (PBC). In presence of metabolic components of fatty-liver-disease (MAFLD), the liver fibrosis progression risk is higher. The aim of this study was to evaluate lifestyle of PBC patients compared to controls.

      Methods

      In a prospective, multicenter study 107 PBC patients were enrolled; among these, 54 subjects were age-and sex-matched with 54 controls with a propensity-score-matching-analysis. Eating habits and physical activity were evaluated, respectively, with a food-frequency-questionnaire and with a short pre-validated-questionnaire. The adherence to Mediterranean diet was assessed with the alternate Mediterranean diet score.

      Results

      The total fat intake was higher in controls than in PBC (p=0.004), unless above the national recommendations in both groups. Moreover, in PBC monounsaturated-fat and polyunsaturated-fatty-acid intakes and the adherence to Mediterranean diet were significantly lower than in controls (p<0.001, p=0.005 and p<0.001 respectively). Regarding physical activity, PBC subjects had a sedentary behavior as well as controls.

      Conclusions

      The lifestyle of both PBC and controls is at high risk of developing MAFLD. Therefore, hepatologists should regularly evaluate eating habits and physical activity in PBC patients and promote a lifestyle change to reduce liver disease progression risk.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Digestive and Liver Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. EASL clinical practice guidelines. The diagnosis and management of patients with primary biliary cholangitis.
        J Hepatol. 2017; 67: 145-172
        • Carbone M
        • Mells GF
        • Pells G
        • et al.
        Sex and age are determinants of the clinical phenotype of primary biliary cirrhosis and response to ursodeoxycholic acid.
        Gastroenterology. 2013; 144: 560-569
        • Lleo A
        • Leung PSC
        • Hirschfield GM
        • et al.
        The pathogenesis of primary biliary cholangitis: a comprehensive review.
        Semin Liver Dis. 2020; 40: 34-48
        • Gulamhusein AF
        • Hirschfield GM.
        Primary biliary cholangitis: pathogenesis and therapeutic opportunities.
        Nat Rev Gastroenterol Hepatol. 2020; 17: 93-110
        • Ali AH
        • Carey EJ
        • Lindor KD.
        Diagnosis and management of primary biliary cirrhosis.
        Expert Rev Clin Immunol. 2014; 10: 1667-1678
        • Carey EJ
        • Ali AH
        • Lindor KD.
        Primary biliary cirrhosis.
        Lancet. 2015; 386: 1565-1575
        • Murillo PCF
        • Goet JC
        • Lammers WJ
        • et al.
        Milder disease stage in patients with primary biliary cholangitis over a 44-year period: a changing natural history.
        Hepatology. 2018; 67: 1920-1930
        • Su TC
        • Hwang JJ
        • Kao JH.
        Hypercholesterolemia in primary biliary cirrhosis.
        N Engl J Med. 2007; 357: 1561-1562
        • Wah-Suarez MI
        • Danford CJ
        • Patwardhan VR
        • et al.
        Hyperlipidaemia in primary biliary cholangitis: treatment, safety and efficacy.
        Frontl Gastroenterol. 2019; 10: 401-408
        • Allocca M
        • Crosignani A
        • Gritti A
        • et al.
        Hypercholesterolemia is not associated with early atherosclerotic lesions in primary biliary cirrhosis.
        Gut. 2006; 55: 1795-1800
        • Floreani A
        • Variola A
        • Niro G
        • et al.
        Plasma adiponectin levels in primary biliary cirrhosis: a novel perspective for link between hypercholesterolemia and protection against atherosclerosis.
        Am J Gastroenterol. 2008; 103: 1959-1965
        • Loaeza-del Castillo A
        • Gaytán-Santillán A
        • López-Tello A
        • et al.
        Patterns of serum lipids derangements and cardiovascular risk assessment in patients with primary biliary cholangitis.
        Ann Hepatol. 2019; 18: 879-882
        • Hindi M
        • Levy C
        • Couto CA
        • et al.
        Primary biliary cirrhosis is more severe in overweight patients.
        J Clin Gastroenterol. 2013; 47: e28-e32
        • Boursier J
        • Decraecker M
        • Bourlière M
        • et al.
        Quality criteria for the measurement of liver stiffness.
        Clin Res Hepatol Gastroenterol. Jan 2022; 46101761
        • Sasso M
        • Audière S
        • Kemgang A
        • et al.
        Liver steatosis assessed by controlled attenuation parameter (cap) measured with the xl probe of the fibroscan: a pilot study assessing diagnostic accuracy.
        Ultrasound Med Biol. Jan 2016; 42: 92-103
        • Corpechot C
        • Carrat F
        • Gaouar F
        • et al.
        Liver stiffness measurement by vibration-controlled transient elastography improves outcome prediction in primary biliary cholangitis.
        J Hepatol. 2022 Jun 28; (S0168-8278(22)00411-1)
        • Gnagnarella P
        • Parpinel M
        • Salvini S
        • et al.
        The update of the Italian food composition database.
        J Food Compos Anal. 2004; 17: 509e22
        • Trichopoulou A
        • Kouris-Blazos A
        • Wahlqvist ML
        • et al.
        Diet and overall survival in elderly people.
        BMJ. 1995; 311: 1457e60
        • Hoffman R
        • Gerber M.
        Evaluating and adapting the Mediterranean diet for non-Mediterranean populations: a critical appraisal.
        Nutr Rev. 2013; 71: 573e84
      2. AAVV. Gruppo di esperti costituito presso l'Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione (INRAN). Linee guida per una sana alimentazione italiana. Ministero delle Politiche Agricole e Forestali e INRAN. 2003. https://www.fao.org/3/as686o/as686o.pdf. Accessed June 5, 2022.

        • Craig CL
        • Marshall AL
        • Sjostrom M
        • et al.
        International physical activity questionnaire: 12-country reliability and validity.
        Med Sci Sports Exerc. 2003; 35: 1381-1395
        • European Association for the Study of the Liver (EASL)
        European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease.
        J Hepatol. Jun 2016; 64: 1388-1402
        • LARN
        IV Revisione dei Livelli di Assunzione di Riferimento di Nutrienti ed energia per la popolazione italiana.
        Società Italiana di Nutrizione Umana (SINU), 2014 (Accessed June 5, 2022)
        • Jensen MD
        • Ryan DH
        • Apovian CM
        • et al.
        2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American college of cardiology/American heart association task force on practice guidelines and the obesity society.
        J Am Coll Cardiol. 2014; 63: 2985-3023
        • de Cuevillas B
        • Alvarez-Alvarez I
        • Riezu-Boj JI
        • et al.
        The hypertriglyceridemic-waist phenotype as a valuable and integrative mirror of metabolic syndrome traits.
        Sci Rep. 2021 Nov 8; 11: 21859
        • Bedogni G
        • Miglioli L
        • Masutti F
        • et al.
        Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study.
        Hepatology. 2005; 42: 44-52
        • Seidell JC.
        Waist circumference and waist/hip ratio in relation to all-cause mortality, cancer and sleep apnea.
        Eur J Clin Nutr. Jan 2010; 64: 35-41
        • Sekiya M
        • Yahagi N
        • Matsuzaka T
        • et al.
        Polyunsaturated fatty acids ameliorate hepatic steatosis in obese mice by SREBP-1 suppression.
        Hepatology. 2003; 38: 1529-1539
        • Levy JR
        • Clore JN
        • Stevens W.
        Dietary n-3 polyunsaturated fatty acids decrease hepatic triglycerides in Fischer 344 rats.
        Hepatology. 2004; 39: 608-616
        • Rosqvist F
        • Iggman D
        • Kullberg J
        • et al.
        Overfeeding polyunsaturated and saturated fat causes distinct effects on liver and visceral fat accumulation in humans.
        Diabetes. 2014; 63: 2356-2368
        • Bjermo H
        • Iggman D
        • Kullberg J
        • et al.
        Effects of n-6 PUFAs compared with SFAs on liver fat, lipoproteins, and inflammation in abdominal obesity: a randomized controlled trial.
        Am J Clin Nutr. 2012; 95: 1003-1012
        • Sawada N
        • Inoue M
        • Iwasaki M
        • et al.
        Consumption of n-3 fatty acids and fish reduces risk of hepatocellular carcinoma.
        Gastroenterology. 2012; 142: 1468-1475
        • Ioannou GN
        • Morrow OB
        • Connole ML
        • et al.
        Association between dietary nutrient composition and the incidence of cirrhosis or liver cancer in the United States population.
        Hepatology. 2009; 50: 175-184
        • Davis C
        • Bryan J
        • Hodgson J
        • et al.
        Definition of the Mediterranean diet; a literature review.
        Nutrients. 2015; 7: 9139-9153
        • Grosso G
        • Mistretta A
        • Frigiola A
        • et al.
        Mediterranean diet and cardiovascular risk factors: a systematic review.
        Crit Rev Food Sci Nutr. 2014; 54: 593-610
        • Estruch R
        • Ros E
        • Salas-Salvado J
        • et al.
        Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts.
        N Engl J Med. 2018; 378: e34
        • Salas-Salvado J
        • Bullo M
        • Estruch R
        • et al.
        Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial.
        Ann Intern Med. 2014; 160: 1-10
        • Ryan MC
        • Itsiopoulos C
        • Thodis T
        • et al.
        The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease.
        J Hepatol. 2013; 59: 138-143
        • Vereecken CA
        • Todd J
        • Roberts C
        • et al.
        Television viewing behaviour and associations with food habits in different countries.
        Public Health Nutr. 2006; 9: 244-250
        • Grøntved A
        • Hu FB.
        Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a meta-analysis.
        JAMA. 2011 Jun 15; 305: 2448-2455
        • Keating SE
        • Hackett DA
        • Parker HM
        • et al.
        Effect of aerobic exercise training dose on liver fat and visceral adiposity.
        J Hepatol. 2015; 63: 174-182
        • Cuthbertson DJ
        • Shojaee-Moradie F
        • Sprung VS
        • et al.
        Dissociation between exercise-induced reduction in liver fat and changes in hepatic and peripheral glucose homoeostasis in obese patients with non-alcoholic fatty liver disease.
        Clin Sci (Lond). 2016; 130: 93-104
        • Shojaee-Moradie F
        • Cuthbertson DJ
        • Barrett M
        • et al.
        Exercise training reduces liver fat and increases rates of VLDL clearance but not VLDL production in NAFLD.
        J Clin Endocrinol Metab. 2016; 101: 4219-4228
        • Van der Poorten D
        • Milner KL
        • Hui J
        • et al.
        Visceral fat: a key mediator of steatohepatitis in metabolic liver disease.
        Hepatology. 2008; 48: 449-457
        • De Veer RC
        • Harms MH
        • Corpechot C
        • et al.
        Liver transplant-free survival according to alkaline phosphatase and GLOBE score in patients with primary biliary cholangitis treated with ursodeoxycholic acid.
        Aliment Pharmacol Ther. Nov 2022; 56: 1408-1418
        • Rong G
        • Wang H
        • Bowlus CL
        • et al.
        Incidence and risk factors for hepatocellular carcinoma in primary biliary cirrhosis.
        Clin Rev Allergy Immunol. Jun 2015; 48: 132-141
        • Rigopoulou EI
        • Dalekos GN.
        Current trends and characteristics of hepatocellular carcinoma in patients with autoimmune liver diseases.
        Cancers (Basel). 2021; 13: 1023