title: Concurrent Obesity, Diabetes, and Steatosis Increase Risk of Advanced Fibrosis Among HCV Patients: A Systematic Review.
abstract: BACKGROUND
  Rising rates of obesity, diabetes mellitus (DM), and nonalcoholic fatty liver disease among patients with chronic hepatitis C virus infection (HCV) may contribute to more rapid disease progression.
  
  
  OBJECTIVE
  To evaluate the impact of concurrent obesity, DM, and steatosis on disease progression among HCV patients.
  
  
  METHODS
  A systematic review using structured keyword search of MEDLINE and EMBASE from January 1, 2001, to July 1, 2014, was performed to identify original articles evaluating the association of obesity, DM, and steatosis with advanced fibrosis (AF) among adults with chronic HCV. Studies involving HCV patients coinfected with human immunodeficiency virus, hepatitis B virus, hepatocellular carcinoma, or other chronic liver diseases were excluded. Quality assessment utilized Newcastle-Ottawa Scale.
  
  
  RESULTS
  Twenty cohort studies met inclusion criteria for analyses. Obesity was associated with increased risk of AF in seven studies with effect size ranging from OR 1.08 to 7.69. However, four studies did not demonstrate a significant association between obesity and AF. The presence of advanced steatosis among HCV patients was associated with increased risk of AF in 12 studies (OR 1.80-14.3). Concurrent DM was associated with increased risk of AF in six studies (OR 2.25-9.24). Thirteen studies were good quality, and seven studies were fair quality.
  
  
  CONCLUSIONS
  Concurrent DM and steatosis are associated with increased risk of AF among chronic HCV patients. The majority of studies demonstrated significant associations of obesity with AF. Targeted interventions to optimize management of obesity-related diseases among HCV patients may help mitigate HCV disease progression.
authors.affiliation: Division of Gastroenterology and Hepatology, Highland Hospital, Alameda Health System - Highland Hospital Campus, Highland Care Pavilion 5th Floor, Endoscopy Unit, 1411 East 31st Street, Oakland, CA, 94602, USA, harleendyal@gmail.com.
authors.forename: Harleen K
authors.initials: HK
authors.lastname: Dyal
authors.forename: Maria
authors.initials: M
authors.lastname: Aguilar
authors.forename: Taft
authors.initials: T
authors.lastname: Bhuket
authors.forename: Benny
authors.initials: B
authors.lastname: Liu
authors.forename: Edward W
authors.initials: EW
authors.lastname: Holt
authors.forename: Sharon
authors.initials: S
authors.lastname: Torres
authors.forename: Ramsey
authors.initials: R
authors.lastname: Cheung
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
mesh_terms: D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000453:epidemiology*; D018450:Disease Progression; D005234:Fatty Liver / Q000150:complications / Q000453:epidemiology*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology*; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D012307:Risk Factors