title: Sexual Dimorphic Metabolic Alterations in Hepatitis C Virus-infected Patients: A Community-Based Study in a Hepatitis B/Hepatitis C Virus Hyperendemic Area.
abstract: The impact of sex on metabolic alterations in individuals with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection remains elusive.A community-based study was performed to assess sex, age, body mass index, the lipid profile, blood pressure, glucose, alanine aminotransferase, HBV surface antigen (HBsAg), and HCV antibody levels, smoking and alcohol drinking habits, and cardiometabolic diseases, including diabetes, hypertension, cardiovascular events, and renal diseases. The HCV-RNA level and genotype were further assessed in HCV antibody-positive subjects, and the hepatitis B e antigen and HBV-DNA levels were further examined in HBsAg-positive subjects.Among the 10,959 adults enrolled, 1949 (17.8%) and 1536 (14.0%) were HBV and HCV-infected, respectively. Univariate and multivariate analyses showed that the lipid profile and hypertension were independently associated with HCV infection (95% confidence intervals of odds ratios [OR 95% CI]: total cholesterol [TC] = 0.508-0.677; triglycerides = 0.496-0.728; hypertension = 0.669-0.937), but not with HBV infection. Consistently, HCV, but not HBV infection, was negatively associated with the TC and triglyceride levels (OR 95% CI for TC: 0.450-0.601; triglycerides: 0.443-0.671). Generalized linear models revealed that HCV infection, sex, and age interactively affected the lipid profile (OR 95% CI TC = 1.189-1.385; triglycerides = 1.172-5.289). Age-stratification analysis showed that the lipid levels were lower in both the HCV-positive females aged ≥49 years (TC, P < 0.001; triglycerides, P = 0.001) and males of all ages (TC, P < 0.001; triglycerides, P < 0.001) compared with their sex and age-matched HCV-negative counterparts. HCV infection was associated with a higher body mass index (≥49 years, β = 0.405, P = 0.002) and increased rates of cardiovascular events (<49 years, OR 95% CI 1.23-9.566), diabetes (≥49 years, OR 95% CI 1.114-1.932), and renal diseases (≥49 years, OR 95% CI 1.23-9.55), and with a lower rate of hypertension (≥49 years, OR 95% CI 0.616-0.964) in the females, but not in the males, as determined by multivariate analyses.Only HCV infection was associated with metabolic alterations in this HBV/HCV-hyperendemic area. Females aged ≥49 years and males of all ages exhibited HCV-associated hypolipidemia. HCV-associated cardiometabolic diseases were evident only in the females. Sex dimorphism in HCV-associated metabolic complications warrants personalized follow-up of HCV-positive patients.
authors.affiliation: From the Department of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan (J-HH); College of Nursing, Chang Gung University of Science and Technology, Putz City, Chiayi County, Taiwan (M-YC); Liver Research Center and Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan (C-TY, M-LC); Division of Infection Disease, Department of Medicine, Chang Gung Memory Hospital, Chia-yi, Taiwan (H-SL); Division of Cardiology, Chang-Gung Memorial Hospital, Yunlin, Taiwan (M-SL); Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan (T-JH); and Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, (M-LC).
authors.forename: Jing-Hong
authors.initials: JH
authors.lastname: Hu
authors.forename: Mei-Yen
authors.initials: MY
authors.lastname: Chen
authors.forename: Chau-Ting
authors.initials: CT
authors.lastname: Yeh
authors.forename: Huang-Shen
authors.initials: HS
authors.lastname: Lin
authors.forename: Ming-Shyan
authors.initials: MS
authors.lastname: Lin
authors.forename: Tung-Jung
authors.initials: TJ
authors.lastname: Huang
authors.forename: Ming-Ling
authors.initials: ML
authors.lastname: Chang
mesh_terms: D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D005260:Female; D016174:Hepacivirus / Q000276:immunology; D006509:Hepatitis B / Q000378:metabolism; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006526:Hepatitis C / Q000150:complications / Q000378:metabolism*; D006801:Humans; D006973:Hypertension / Q000150:complications; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000378:metabolism; D008875:Middle Aged; D012737:Sex Factors; D013624:Taiwan
chemical_list: D001786:Blood Glucose; D006514:Hepatitis B Surface Antigens; D008055:Lipids; D000410:Alanine Transaminase