title: Insulin resistance and diabetes increase fibrosis in the liver of patients with genotype 1 HCV infection.
abstract: OBJECTIVE
  Metabolic factors may affect the course of chronic hepatitis C (CHC). Insulin resistance (IR) determines steatosis, but its direct role in affecting progression of hepatic fibrosis is less clear. We aimed to assess whether increasing degrees of IR, up to overt diabetes, are linked to steatosis and higher stages of fibrosis in patients with CHC resulting from genotype 1 HCV (G1-HCV).
  
  
  METHODS
  Two hundred one consecutive patients with G1-HCV infection were evaluated by liver biopsy and anthropometric and metabolic measurements, including IR, by the homeostasis model assessment (HOMA). Nondiabetic patients were defined as insulin resistant if HOMA-IR was >2.7. All biopsies were scored by one pathologist for staging and grading (Scheuer), and graded for steatosis.
  
  
  RESULTS
  Ninety-six patients were noninsulin resistant (group 1), 76 were insulin resistant without diabetes (group 2), and 29 were diabetic (group 3). At multivariate analysis, fibrosis of >/=3 was independently associated with high necroinflammatory activity (odds ratio [OR] 2.994, 95% confidence interval [CI] 1.422-6.098), low platelets (OR 0.994, 95% CI 0.981-0.999), low cholesterol (OR 0.987, 95% CI 0.976-0.998), high ferritin (OR 1.002, 95% CI 1.001-1.004), and a high prevalence of IR (OR 2.692, 95% CI 1.463-4.954). Diabetic patients were twice as likely to have severe fibrosis (60%) than those with IR but no diabetes (30%) (P= 0.006). The degree of steatosis and that of fibrosis were weakly associated with each other (P= 0.42).
  
  
  CONCLUSIONS
  In subjects with CHC resulting from G1-HCV, IR and overt diabetes are major determinants of advanced fibrosis, regardless of the degree of steatosis, mainly in the presence of severe necroinflammation.
authors.affiliation: Cattedra ed Unità Operativa di Gastroenterologia, University of Palermo, Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Petta
authors.forename: Calogero
authors.initials: C
authors.lastname: Cammà
authors.forename: Vito
authors.initials: V
authors.lastname: Di Marco
authors.forename: Nicola
authors.initials: N
authors.lastname: Alessi
authors.forename: Daniela
authors.initials: D
authors.lastname: Cabibi
authors.forename: Rosalia
authors.initials: R
authors.lastname: Caldarella
authors.forename: Anna
authors.initials: A
authors.lastname: Licata
authors.forename: Fatima
authors.initials: F
authors.lastname: Massenti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantino
authors.forename: Giulio
authors.initials: G
authors.lastname: Marchesini
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
mesh_terms: D001706:Biopsy; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000473:pathology; D005234:Fatty Liver / Q000453:epidemiology / Q000473:pathology; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000473:pathology; D008111:Liver Function Tests; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors
chemical_list: D012367:RNA, Viral