title: A 24-week dietary and physical activity lifestyle intervention reduces hepatic insulin resistance in the obese with chronic hepatitis C.
abstract: OBJECTIVE
  Obesity- and virus-mediated insulin resistance (IR) are associated with adverse hepatic and metabolic outcomes in chronic hepatitis C (CHC). This study evaluates the tolerability and effects of a dietary and physical activity (PA) intervention in obese patients with insulin-resistant CHC.
  
  
  METHODS
  Obese patients (body mass index, BMI ≥30 kg/m(2) ) with CHC were recruited prospectively. Non-diabetic patients with IR (homeostasis model assessment of IR, HOMA-IR >2.0) proceeded to a 24-week lifestyle intervention comprising pedometer monitored increase in PA (≥10 000 steps/day) and an individualised dietary plan.
  
  
  RESULTS
  Ten non-cirrhotic and six cirrhotic patients [age 52 ± 8.5 years, BMI 35.9 (31.46-38.21)kg/m(2) ] were recruited, of whom all 16 (100%) completed the 24-week protocol. Increase in PA from 6853 (2440-9533) to 10 697 (7959-13566) steps/day (P = 0.001) and reduction in caloric intake from 2263 (1805.4-2697.0) to 1281 (1099.5-1856.3) kcal/day (equivalent to reduction of median 33% (25.3-49.8%), P < 0.001) were achieved. These behaviour changes led to a BMI reduction to 31.21 (28.72-36.10) (P < 0.001) and the HOMA-IR fell from 3.62 (2.75-4.87) to 2.08 (1.82-3.59) (P = 0.002). The hepatic insulin sensitivity index (ISI) improved significantly, but the skeletal muscle ISI did not. At week 24, 8/16 (50%) patients were no longer insulin-resistant (P = 0.008).
  
  
  CONCLUSIONS
  This 24-week intervention reduced BMI and reversed IR in significant proportion of patients. Such adjunctive therapy may improve hepatic and metabolic status in obese insulin-resistant CHC.
authors.affiliation: Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Venessa
authors.initials: V
authors.lastname: Pattullo
authors.forename: Andres
authors.initials: A
authors.lastname: Duarte-Rojo
authors.forename: Wael
authors.initials: W
authors.lastname: Soliman
authors.forename: Florencia
authors.initials: F
authors.lastname: Vargas-Vorackova
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
authors.forename: Ivan G
authors.initials: IG
authors.lastname: Fantus
authors.forename: Johane
authors.initials: J
authors.lastname: Allard
authors.forename: Jenny
authors.initials: J
authors.lastname: Heathcote
mesh_terms: D000886:Anthropometry; D001481:Basal Metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009765:Obesity / Q000150:complications* / Q000178:diet therapy* / Q000628:therapy*; D009864:Ontario; D011446:Prospective Studies; D018709:Statistics, Nonparametric