Effect of weight reduction on liver histology and biochemistry in patients with chronic hepatitis C
- I J Hickman1,
- A D Clouston2,
- G A Macdonald3,
- D M Purdie4,
- J B Prins5,
- S Ash1,
- J R Jonsson6,
- E E Powell7
- 1Department of Nutrition and Operational Support Services, Princess Alexandra Hospital, Brisbane, Australia.
- 2Department of Pathology, University of Queensland, Brisbane, Australia.
- 3Department of Medicine, University of Queensland, and the Population and Clinical Sciences Division, Queensland Institute of Medical Research, Brisbane, Australia.
- 4Population and Clinical Sciences Division, Queensland Institute of Medical Research, Brisbane, Australia.
- 5Department of Endocrinology, Princess Alexandra Hospital, Brisbane, Australia.
- 6Department of Surgery, University of Queensland, Brisbane, Australia.
- 7Department of Surgery, University of Queensland, and Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia.
- Correspondence to:
Dr E E Powell, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Brisbane, Queensland 4102, Australia;
- Accepted 20 November 2001
Background: Steatosis occurs in more than 50% of patients with chronic hepatitis C and is associated with increased hepatic fibrosis. In many of these patients the pathogenesis of steatosis appears to be the same as for patients with non-alcoholic fatty liver disease—that is, related to visceral adiposity and obesity.
Methods: The effect of a three month weight reduction programme on liver biochemistry and metabolic parameters was examined in 19 subjects with steatosis and chronic hepatitis C. Paired liver biopsies were performed in 10 subjects, prior to and 3–6 months following the intervention, to determine the effect of weight loss on liver histology.
Results: There was a mean weight loss of 5.9 (3.2) kg and a mean reduction in waist circumference of 9.0 (5.0) cm. In 16 of the 19 patients, serum alanine aminotransferase levels fell progressively with weight loss. Mean fasting insulin fell from 16 (7) to 11 (4) mmol/l (p<0.002). Nine of 10 patients with paired liver biopsies had a reduction in steatosis irrespective of viral genotype. In these subjects the median modified Knodell fibrosis score decreased from 3 to 1 (p=0.04) and activated stellate cells significantly decreased (p<0.004).
Conclusions: Weight loss in patients with chronic hepatitis C may be associated with a reduction in steatosis and abnormal liver enzymes and an improvement in fibrosis, despite the persistence of the virus. Weight reduction may provide an important adjunct treatment strategy for patients with chronic hepatitis C.
- HCV, hepatitis C virus
- BMI, body mass index
- ALT, alanine aminotransferase
- α-SMA, α-smooth muscle actin
- HOMA, homeostasis model of assessment