Obesity and Non-Alcoholic Fatty Liver Disease in Chronic Hepatitis C

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Abstract

Background

Superimposed non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) may affect HCV-related fibrosis. We performed a study to determine the relationship between NAFLD and chronic hepatitis C.

Methods

One hundred and twenty patients with chronic hepatitis C and available liver biopsies were included. Baseline liver biopsies were read by 1 hepatopathologist using Metavir, as well as a fatty liver pathology protocol. Patients’ baseline clinical, demographic, and virologic data were associated with the extent of steatosis (>33% vs. ≤33%), the type of fatty liver (no steatosis vs. steatosis only vs. NASH), and the stage of fibrosis seen on the liver biopsy.

Results

Seventy percent of patients were men and 80% were white. The mean age was 47.48 ± 5.70 years, mean BMI was 29.01 ± 5.01 kg/m2, and mean waist to hip ratio (W/H) was 0.90 ± 0.08. Patients with higher grade of steatosis had higher BMI (32.83 ± 6.26 vs. 28.49 ± 4.62, P = 0.034), more likely to have genotype 3 (21.4% vs. 5.7%, P = 0.037) and advanced fibrosis (92.9% vs. 62.3%, P = 0.033) than those with lower grade of steatosis. Of these, only HCV-genotype 3 remained independently associated with higher grade of steatosis. When patients with superimposed NASH (n = 22) were compared with those with only steatosis (n = 49) and those without steatosis (n = 49), patients with superimposed NASH had more evidence of obesity (BMI: 30.64 ± 5.23 vs. 29.90 ± 5.35 vs. 27.33 ± 4.07, P = 0.008; W/H: 0.97 ± 0.06 vs. 0.91 ± 0.08 vs. 0.87 ± 0.07, P < 0.001), more commonly infected with HCV genotype 3 (14% vs. 12% vs. 0%, P = 0.036) and had more advanced fibrosis (95.5% vs. 75.5% vs. 42.9%, P < 0.001). Race, gender, and age did not affect extent of steatosis or presence of superimposed NASH.

Conclusion

In conclusion, markers of obesity (BMI and W/H) and HCV genotype 3 are associated with the extent of steatosis and type of fatty liver. Higher grade of steatosis and presence of superimposed NASH are both associated with advanced hepatic fibrosis.

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