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Importance of fatigue and its measurement in chronic liver disease

World Journal of Gastroenterology 2019年第28期25卷 3669-3683页

作者： Lynn H Gerber ali a weinstein Rohini Mehta Zobair M Younossi Department of Medicine Beatty Center for Liver and Obesity Research Inova Health System Falls Church VA 22042 United States Center for the Study of Chronic Illness and Disability George Mason University Fairfax VA 22030 United States Beatty Center for Liver and Obesity Research Inova Health System Falls Church VA 22042 United States

The mechanisms of fatigue in the group of people with non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are protean. The liver is central in the pathogenesis of fatigue because it uniquely regulates much of the storage, release and production of substrate for energy generation. It is exquisitely sensitive to the feedback controlling the uptake and release of these energy generation substrates. Metabolic contributors to fatigue, beginning with the uptake of substrate from the gut, the passage through the portal system to hepatic storage and release of energy to target organs (muscle and brain) are central to understanding fatigue in patients with chronic liver disease. Inflammation either causing or resulting from chronic liver disease contributes to fatigue, although inflammation has not been demonstrated to be causal. It is this unique combination of factors, the nexus of metabolic abnormality and the inflammatory burden of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis that creates pathways to different types of fatigue. Many use the terms central and peripheral fatigue. Central fatigue is characterized by a lack of self-motivation and can manifest both in physical and mental activities. Peripheral fatigue is classically manifested by neuromuscular dysfunction and muscle weakness. Therefore, the distinction is often seen as a difference between intention (central fatigue) versus ability (peripheral fatigue). New approaches to measuring fatigue include the use of objective measures as well as patient reported outcomes. These measures have improved the precision with which we are able to describe fatigue. The measures of fatigue severity and its impact on usual daily routines in this population have also been improved, and they are more generally accepted as reliable and sensitive. Several approaches to evaluating fatigue and developing endpoints for treatment have relied of biosignatures associated with fatigue. These have bee

关键词： Fatigue Chronic liver disease Non-alcoholic fatty liver diseases Nonalcoholic steatohepatitis Measurement Patient-reported outcomes

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Interrelationship between physical activity and depression in nonalcoholic fatty liver disease

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World Journal of Hepatology 2022年第3期14卷 612-622页

作者： ali a weinstein Leyla De Avila Saisruthi Kannan James M Paik Pegah Golabi Lynn H Gerber Zobair M Younossi Betty and Guy Beatty Center for Integrated Research Inova Health SystemFalls ChurchVA 22042United States Global and Community Health George Mason UniversityFairfaxVA 22030United States Center for Liver Disease Department of MedicineInova Fairfax Medical CampusFalls ChurchVA 22042United States Inova Medicine Inova Health SystemFalls ChurchVA 22042United States

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is associated with a sedentary lifestyle and depressive *** is also well established that physical inactivity and depressive symptoms are ***,an investigation of the interaction between all of these factors in NAFLD has not been previously *** To investigate the interrelationship between physical inactivity and depressive symptoms in individuals with *** Data from the Rancho Bernardo Study of Healthy Aging were utilized.589 individuals were included in the analyses(43.1%male;95.8%non-Hispanic white;aged 60.0±7.0 years).NAFLD was defined by using the hepatic steatosis index,depression using the Beck Depression Inventory,and physical activity by selfreport of number of times per week of strenuous *** generalized linear regression models with Gamma distribution were performed to investigate the proposed *** About 40%of the sample had evidence of NAFLD,9.3%had evidence of depression,and 29%were physically *** with NAFLD and depression were more likely to be physically inactive(60.7%)compared to individuals with neither NAFLD nor depression(22.9%),individuals with depression without NAFLD(37.0%),and individuals with NAFLD without depression(33.3%).After accounting for various comorbidities(i.e.,age,sex,diabetes,hypertension,obesity),individuals with NAFLD and higher levels of physical activity were at a decreased odds of having depressive symptoms[16.1%reduction(95%confidence interval:-25.6 to-5.4%),P=0.004],which was not observed in those without *** Individuals with NAFLD have high levels of physical inactivity,particularly those with depressive *** this group is at high risk for poor outcomes,practitioners should screen for the coexistence of depressive symptoms and *** group should receive appropriate interventions aimed at increasing both participation and levels of intensity of physical activ

关键词： Liver disease Outcomes research Psychiatric disorders Exercise

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Racial Provocation Induces Cortisol Responses in African-Americans

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Open Journal of Medical Psychology 2013年第4期2卷 151-157页

作者： ali A. weinstein Angela Termini Joshua B. Kazman Stacey A. Zeno Preetha Abraham Patricia A. Deuster Center for the Study of Chronic Illness and Disability George Mason University Fairfax USA Department of Military and Emergency Medicine Uniformed Services University of the Health Sciences Bethesda USA

Purpose: To examine salivary cortisol responses to a racially-charged stimulus in a group of African-American individuals. Methods: A nonrandom sample of 245 (age: 43.8 ± 11.1 years;64% female) African-American individuals was recruited by advertisements. Specifically, salivary cortisol was assessed prior to and after being exposed to a racially-charged movie clip. In addition, the salivary cortisol was assessed in?the morning and evening of the day following exposure to the racially-charged movie clip. Results: A statistically significant increase in cortisol was found (P 0.005) in the whole sample. High cortisol responders (highest tertile) and low cortisol responders (lowest tertile) were compared. The high cortisol responders had an elevated cortisol level the following morning (P 0.05) that abated by the evening sample (P > 0.20). In addition, the high cortisol responders who were younger, had lower waist to hip ratios, and experienced less lifetime discrimination than the low cortisol responders (P’s 0.05). Conclusions: The findings of an increase in cortisol in response to a racial provocation may provide a potential explanatory factor for the increased rates of cardiovascular disease in African-American individuals.

关键词： Mental Stress Racial Stressors Ethnicity Cardiovascular Disease

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