The impact of insulin resistance, serum adipocytokines and visceral obesity on steatosis and fibrosis in patients with chronic hepatitis C.
OBJECTIVE
To assess whether host metabolic factors influence the degree of hepatic steatosis and fibrosis in patients infected with hepatitis C virus, and to evaluate the impact of anti-viral therapy on insulin resistance and serum levels of adipocytokines.


METHODS
Clinical and biochemical features, anthropometrical characteristics, and levels of fasting insulin, leptin, adiponectin and resistin were measured in 'naïve' patients with chronic hepatitis C, before, during and after therapy with Peg-Interferon-alpha 2a plus Ribavirin.


RESULTS
Forty-eight patients were included (M/F 28/20; mean age 50.0 +/- 12.6 years; 62.5% genotype-1). Body mass index was 26.4 +/- 4.0 kg/m(2), and visceral obesity was present in 24 patients. At multivariate analysis (RR; 95% CI), steatosis was associated to older age (1.08; 1-1.18), necroinflammatory activity (17.67; 1.6-194.46), and raised insulin levels (1.39; 1.1-1.77). Fibrosis was related to necroinflammatory activity (25.73; 2.54-261.11), and steatosis (6.47; 1.09-38.29). Sustained viral response was achieved by 62.5% of patients and was associated with younger age (0.92; 0.85-0.99), genotype non-1 (10.61; 1.52-73.76) and absence of visceral obesity (13.78; 2.36-80.29). At the end of follow-up, insulin and the homeostasis model assessment for insulin resistance were reduced and adiponectin increased when compared with baseline, all unrelated to the outcome of treatment.


CONCLUSIONS
Visceral obesity correlates with the degree of steatosis and fibrosis, and it negatively affects treatment response. Significant changes of insulin resistance and adipocytokines occur under treatment, irrespective of virological outcome.
Lo Iacono
O
O
Department of Gastroenterology, University of Palermo, Palermo, Italy. oreloia@hotmail.com
Venezia
G
G
Petta
S
S
Mineo
C
C
De Lisi
S
S
Di Marco
V
V
Rodolico
V
V
Amato
M
M
Ferraro
D
D
Giordano
C
C
Almasio
P L
PL
Craxí
A
A
D017667:Adipocytes / Q000187:drug effects*; D000328:Adult; D000998:Antiviral Agents / Q000378:metabolism / Q000627:therapeutic use*; D005234:Fatty Liver / Q000821:virology; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D050152:Intra-Abdominal Fat / Q000187:drug effects; D008103:Liver Cirrhosis / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000378:metabolism; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012254:Ribavirin