title: Chronic hepatitis C and superimposed nonalcoholic fatty liver disease.
abstract: OBJECTIVE
  Hepatitis C and nonalcoholic fatty liver disease (NAFL) are the two most common forms of liver disease in the United States. Recently, obesity and its associated risk factors have been suggested to enhance HCV-related fibrosis. The aim of this study was to assess the impact of hepatic steatosis, steatohepatitis, and its associated risk factors on HCV-related fibrosis.
  
  
  METHODS
  Patients with untreated, biopsy-proven, chronic hepatitis C (6/97-3/99) were included. Clinical and demographic data at the time of liver biopsy were obtained from chart review and verified by telephone survey. One hepatopathologist reviewed all pathologic specimens, using the modified histological activity index score and the Ishak staging for fibrosis and a NAFL pathologic protocol.
  
  
  RESULTS
  One hundred and seventy patients with hepatitis C were included [age: 48.7+/-9.33 (years), body mass index (BMI): 28.1+/-5.7 (kg/m2) and type 2 diabetes mellitus (DM): 14%]. Of these, 77 (45.3%) had no or mild fibrosis and 93 (54.7%) had advanced fibrosis. Hepatic steatosis was seen in 90 (52.9%) patients. The grade of steatosis was associated with markers of obesity only. Age (p=0.002), type 2 DM (p=0.04), and superimposed steatohepatitis (p=0.047) were independently associated with advanced fibrosis. Superimposed nonalcoholic steatohepatitis (NASH) was seen in 17 (10%) patients. Patients with superimposed NASH were mostly obese (76.5%), males (62%) with 16% having type 2 diabetes and a BMI 33.8+/-7.12.
  
  
  CONCLUSIONS
  In patients with chronic hepatitis C, type 2 DM and superimposed steatohepatitis are independently associated with advanced fibrosis.
authors.affiliation: Department of Gastroenterology and Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Ong
authors.forename: Z M
authors.initials: ZM
authors.lastname: Younossi
authors.forename: C
authors.initials: C
authors.lastname: Speer
authors.forename: A
authors.initials: A
authors.lastname: Olano
authors.forename: T
authors.initials: T
authors.lastname: Gramlich
authors.forename: N
authors.initials: N
authors.lastname: Boparai
mesh_terms: D000328:Adult; D005234:Fatty Liver / Q000150:complications* / Q000503:physiopathology; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors