title: Ethnicity and body mass index are associated with hepatitis C presentation and progression.
abstract: OBJECTIVE
  Ethnicity and the metabolic syndrome are believed to affect progression of hepatitis C virus (HCV) infection, but the interaction between these factors is unknown. We evaluated the association between elements of the metabolic syndrome and ethnicity in the histologic progression of HCV in a large, diverse cohort.
  
  
  METHODS
  We retrospectively evaluated clinical data and liver biopsy samples from 812 patients who had no cause of liver disease other than HCV infection. Liver biopsies were scored for steatosis, necroinflammatory activity, and fibrosis. For each patient with a known risk factor for viral acquisition, fibrosis index was calculated as an indicator of disease progression.
  
  
  RESULTS
  Hispanics had significantly higher fibrosis index (0.13 +/- 0.09) than non-Hispanic whites (0.11 +/- 0.07) and African Americans (0.10 +/- 0.06; P = .001). Fibrosis index correlated with body mass index (BMI), older age at infection, ethnicity, and degree of steatosis. Cirrhosis was present in 50% of Hispanics, 38% of non-Hispanic whites, and 24% of African Americans (P < .001). The presence of cirrhosis was associated additionally with older age, longer duration of infection, BMI, alcohol consumption, and diabetes. In multivariate analysis, only BMI and ethnicity were associated with both fibrosis index and presentation with cirrhosis. Patients with higher BMIs, diabetes mellitus, and steatosis had higher degrees of necroinflammation.
  
  
  CONCLUSIONS
  Ethnicity and BMI each were associated with the progression of fibrosis and the presence of cirrhosis. Hispanics had the highest fibrosis index and prevalence of cirrhosis, whereas African Americans had the lowest. Ethnic differences in fibrosis index and cirrhosis persisted after controlling for elements of metabolic syndrome.
authors.affiliation: Department of Medicine, University of Illinois, Chicago, Illinois, USA. kallwitz@uic.edu
authors.forename: Eric R
authors.initials: ER
authors.lastname: Kallwitz
authors.forename: Jennifer
authors.initials: J
authors.lastname: Layden-Almer
authors.forename: Manish
authors.initials: M
authors.lastname: Dhamija
authors.forename: Jamie
authors.initials: J
authors.lastname: Berkes
authors.forename: Grace
authors.initials: G
authors.lastname: Guzman
authors.forename: Rita
authors.initials: R
authors.lastname: Lepe
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Cotler
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Layden
mesh_terms: D000328:Adult; D000818:Animals; D001706:Biopsy; D015992:Body Mass Index; D018450:Disease Progression; D005006:Ethnicity / Q000706:statistics & numerical data*; D005234:Fatty Liver / Q000473:pathology; D005260:Female; D005355:Fibrosis / Q000473:pathology; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008099:Liver / Q000378:metabolism* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index