Patrice Winter

Multiple factors predict physical performance in people with chronic liver disease.

ObjectiveThe aim of this study was to assess whether physical performance correlates with metabolic and inflammatory measures in research subjects with chronic liver disease. DesignThis is a prospective, descriptive cohort study correlating performance on a 6-min walk test with cardiorespiratory variables, metabolic measures (glucose [GLU], C-peptide insulin, and lipids), liver enzymes (aspartate aminotransferase and alanine aminotransferase), and the proinflammatory cytokine interleukin-8 (IL-8). ResultsThis study enrolled 51 subjects (18 women) with chronic liver disease: 41% (n = 21) with nonalcoholic fatty liver disease and 59% (n = 30) with hepatitis C virus. Age, resting heart rate, and fasting GLU correlated significantly with distance walked (P’s < 0.05). First quartile “poor performers” (n = 14) and fourth quartile “high performers” (n = 14) showed differences in age, sex, fasting GLU, and IL-8 level (P’s < 0.05). Combining the number of abnormal serum values (IL-8, C-peptide insulin, GLU, aspartate aminotransferase, alanine aminotransferase, high-density lipoprotein, triglyceride, and total cholesterol) did not correlate with distance walked (P > 0.90). However, in multiple regression analysis, a model that included sex, age, resting heart rate, IL-8 level, and fasting GLU level explained approximately 39% of the variance in the distance walked during the test. ConclusionsOlder age, female sex, abnormal levels of the proinflammatory cytokine IL-8, abnormalities of GLU metabolism, and high resting heart rate are associated with poor physical performance in subjects with chronic liver disease. Poor physical performance is associated with physiologic, metabolic, and inflammatory abnormalities in subjects with nonalcoholic fatty liver disease and hepatitis C virus.

Disparities in Activity Level and Nutrition Between Patients With Chronic Hepatitis C and Blood Donors

To compare physical activity levels and dietary choices of patients who have chronic hepatitis C (CHC) with those of blood donors (BDs).

Sa1000 Medications Affecting the Autonomic Nervous System (ANS) Do Not Explain Abnormal Diastolic Blood Pressure in Patients With Chronic Hepatitis C (Ch-C) or Non-Alcoholic Fatty Liver Disease (NAFLD)

Background: Previous work has shown that high resting diastolic blood pressure in patients with liver disease is associated with low levels of physical performance. Anti-hypertensive medications and some other commonly prescribed anti-depression medications can influence the ANS and, in part, may be able to explain these findings. Aim: The purpose of this analysis was to determine whether medication influencing ANS activity such as beta-2 adrenergic agonists may be significantly associated with abnormal diastolic blood pressure in patients with CH-C and NAFLD. Methods: 47 subjects (62% male, 45% NAFLD, 55% HCV, age 50.5 ± 9.0, BMI 31.5 ± 5.8, 59% obese; 37% diagnosed hypertension, 35% hyperlipidemia, 24% diabetes mellitus, 22% metabolic syndrome, AST 50.2 ± 36.5, ALT 58.0 ± 39.0) were enrolled. Current medications of CH-C and NAFLD patients were categorized by mechanism of action and indication along with clinico-demographic information. Pearsons correlation and regression of diastolic blood pressure was run. Results: 27.3% of patients had elevated diastolic blood pressure at baseline. Of these patients, 17.6% were not taking antihypertensive medications, 76.5% were not taking any medications to increase ANS activity. As expected, the use of anti-hypertension medications were diffierent between those diagnosed with hypertension and those without hypertension (p=0.0001). On the other hand, the prevalence of beta-2 adrenergic agonists was not significantly different between the two groups(p=.642). Pearsons correlation showed no significant correlations between diastolic blood pressure and any medication indication. No correlation existed between diastolic blood pressure and either beta-2 adrenergic agonists (r=0.083) or medications with known ANS effects (r=0.071). The medication model of diastolic blood pressure (All current medications = GERD/digestion + depression/sleep + antihypertensive + GABA/anxiety + diabetes + allergy/asthma/pulmonary + hyperlipidemia/hypercholesterolemia + beta2 adrenergic agonists + supplements/other) did not show any correlation (r= 0.266, p=0.427). Conclusions: The presence of beta-2 adrenergic agonists and medications with ANS activity does not significantly impact diastolic pressure in patients with chronic liver diseases. In these patients, the majority of diastolic blood pressure variance cannot be explained by medication. This data suggest that diastolic blood pressure abnormality in chronic liver disease is related to other currently unknown reasons.

Poster 16 Effect of Cancer-Related Fatigue on Cytokine Reactivity to Challenge Tasks in Breast Cancer Survivors

identified as needed but not available included translator/ASL interpreter or communication aides (52.2%), accessible machine (51.9%), accommodation for wheelchair (40.0%), accommodations for difficulty standing (50.0%), and help with positioning of the arm (44.7%). Conclusions: Women with disabilities have lower levels of screening for breast health, and in some disability populations, great mortality levels post breast cancer diagnosis. Although frequency for breast health screening is being re-evaluated, a more positive health care experiences for women with disabilities undergoing breast cancer screening is needed. Level of Evidence: Level IV

Poster 42 Differentiation of Central and Peripheral Fatigue in Breast Cancer Survivors

Objective: To investigate the association between seat elevator (SE) procurement and changes in functional mobility for clients recommended new equipment with SEs. Design: A retrospective analysis was conducted on clients recommended new equipment with SEs. Demographics, procurement data, and Functional Mobility Assessment (FMA) scores were obtained. Clients were divided into 4 groups, based on SE status before and after receiving new equipment: SE to SE (clients with prior SEs who received new SEs); no SE (NSE) to SE; SE to NSE; and NSE to NSE. Analysis was performed on 3 groups (NSE to NSE group was excluded due to insufficient sample). Setting: Assistive Technology clinic. Participants: 83 clients had data from both time points. Age range was 13 to 88 years. Participants were 41.0% female and 59.0% male. Interventions: Procuring new equipment with or without SEs. Main Outcome Measures: Groups were compared with regard to baseline demographics using ANOVA, Chi-square, and Fishers Exact tests. Within each group, Wilcoxon Rank Sum Analyses were used to compare two time points with respect to FMA individual items (on reach and transfer) and total FMA scores. Results: The 3 groups were not significantly different with regard to age, gender, or diagnosis. In the SE to NSE group, a significant decrease in FMA reach score was seen (P 1⁄4 .026). In the SE to SE group, a significant increase in FMA reach score, FMA transfer score, and total FMA was seen (P 1⁄4 .001, P 1⁄4 .002, P 1⁄4 .001, respectively). In the NSE to SE group, a significant increase in FMA reach score and total FMA was seen (P 1⁄4 .041, P 1⁄4 .049, respectively). Conclusions: Because SEs are often denied by insurance, more research is needed on SEs. This is one of the first studies to show that SEs may have a beneficial effect on reach, transfers, and overall functional mobility. Level of Evidence: Level III

Association of Serum Biomarkers With Fatigue in Patients With Chronic Liver Disease

Background and Aims: Fatigue is a common symptom of chronic liver diseases (CLD), including non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis C (CH-C). The mechanisms or correlates of fatigue in these patients have not been well studied. We aimed to determine if there is a correlation between self-reports of physical activity associated fatigue (peripheral fatigue) or more global lack of energy and motivation (central fatigue); with serum markers of inflammation, or with abnormalities of glucose and lipid metabolism. Methods: 31 untreated patients (age 52.5 ±6.8 years, 66.7% male, BMI 32.4 ± 5.5, 26.7% DM, 0% cirrhosis) with CLD (biopsy proven NAFLD or CH-C with viremia) participated in the study. Fasting blood samples were obtained and were assessed for levels of cytokines (IL-6, IL-8, and TNF-α), serotonin, C-peptide insulin, liver enzymes (AST, ALT), glucose, and lipids (triglycerides, total cholesterol, HDL, LDL, and the non-HDL fraction). Cytokines, serotonin, and C-peptide insulin were measured by ELISA following the manufacturers protocols. The remaining parameters were measured by the Cholestech LDX system. Selfreports included standardized and valid measures of depression (short form of CES-D), vitality/energy (vitality subscale of the SF36) and level of activity (Human Activity Profile). Patients were then divided into tertiles by MET value. The middle third was omitted from further analysis; the remaining top third (those with MET >8.8, representing strenuous activity) and bottom third (those with MET 7 and a transformed vitality index score <45. Only patients meeting these criteria were defined as having central fatigue. Groupwise comparisons were made by Mann-Whitney test, and correlations were assessed by Spearman Rho. Results: In comparison to CLD patients without peripheral fatigue, CLD patients who had peripheral fatigue (n=23) had significantly elevated serum levels of IL-6 (7.2±13.5 pg/mL vs. 1.6±0.74 pg/mL, p<0.01) and IL-8 (22.8±11.2 vs. 15.7±6.8 pg/mL, p<0.05); respectively. In terms of central fatigue, the ratio of AST/ALT was significantly lower in CLD patients with central fatigue than those CLD patients without central fatigue (0.862±0.166 vs. 1.118±0.283, p= 0.004). Conclusions: The current study demonstrates that a substantial majority of patients with CLD report significant peripheral fatigue. This type of fatigue is linked to elevated serum levels of IL-6 and IL-8, implying an inflammatory component present in patients with peripheral fatigue but not in those with central fatigue. Further study into the nature and extent of fatigue associated with CLD is warranted.

Poster 222: Association of Hemoglobin Levels With Physical Activity and Vitality Scores in Patients With Chronic Hepatitis C

range, age, gender, diagnosis, body weight and leg length. Results: Of the 100 selected records, 51 had a diagnosis of stroke and 49 patients with TBI. Average age was 44.4 16.4 years. The average body weight was 78.3 17.2 kg. The average SSV was 0.63 m/sec, MV was 1.01 m/sec and the average difference between measures (velocity range) was 0.38 m/sec. There was a significant difference between the gait velocity range of stroke and TBI (P .046). We found a statistically significant positive correlation between SSV and MV (P .0001). When we compared diagnosis to age and gender, there was a statistically significant relationship (P .01 and .0001, respectively). Velocity range differed significantly among the SSV groups (slow versus moderate P .012; slow versus fast P .0001; moderate versus fast P .005). Conclusions: TBI patients were significantly faster than stroke patients, most likely due to a younger age and being male. SSV was less than 50% of the same parameter reported in the literature for normals. Limited MV increase was recorded. A positive relationship between SSV and MV suggests training a patient to walk as fast as possible may be a useful intervention to help them increase SSV.

Poster 229: Fatigue and Physical Performance in Subjects With Chronic Liver Disease

eters (SF-36). Design: The following assessments were administered to 449 obese patients: RolandMorris Disability Questionnaire (RMDQ), Disabilities of the Arm, Shoulder and Hand (DASH), the Western Ontario and McMaster Universities index (WOMAC), SF-12 questionnaire, Short Physical Performance Battery (SPPB), SIO-Obesity correlated Disability Test (TSDOC). Subjects were also requested to execute the 6-minute walking test (6MWT). The TSD-OC is composed by 7 sections (pain; stiffness; activities of daily living and indoor mobility; housework; outdoor activities; occupational activities; social life) and a total of 36 items. The patient is requested to subjectively assess disability for each item by means of a visual analog scale. Setting: Multicentric study coordinated by the SIO and involving 16 center in Italy. Participants: 449 obese subjects (30.5% M, 69.5% F; mean age 51.1 14 years). Results: No significant correlations between BMI and RMDQ, DASH, WOMAC, SF-12 (PCS-12 and MCS-12); a high correlation between BMI and TSDOC, both for the global score and for some items: “pain while carrying loads” (rho 0.47), “difficulty at work” (rho 0.51), “need to be often absent from work” (rho 0.46). Conclusions: Disability in obesity is peculiar and standardized assessments commonly used in rehabilitation settings fail to characterize it. Our study demonstrates that high BMI values are correlated to the global TSDOC score, indicating overall disability. TSD-OC may represent an important instrument to establish the rehabilitation needs in patients with obesity-related disability, to plan appropriate rehabilitation programs and to evaluate their effectiveness