• fatty liver
• calorie restriction
• fibrosis
• stellate cells
• weight loss

The paper by Hickman and colleagues¹ in this issue of Gut[see page89] is important because it shows that simple lifestyle changes inducing weight reduction over three months can lead to a significant reduction in hepatic steatosis and markers of stellate cell activation with a trend to less liver fibrosis. This change in liver histology was associated with a reduction in insulin resistance. Unfortunately, many patients regained their weight at the end of the three months of weekly monitoring of calorie intake and exercise. Nevertheless, it is clear that simple lifestyle changes alone can potentially reduce both the morbidity (development of diabetes) and mortality (fibrosis leading to cirrhosis) related to hepatitis C infection.

These same authors previously showed that hepatic steatosis is common in individuals infected with hepatitis C and that the degree of steatosis and fibrosis correlates well with body mass index.² It is also known that individuals infected with genotype 3 are more likely to have a fatty liver even when they are not overweight.³ A recent illustration demonstrated how eradication of hepatitis C virus following antiviral therapy can lead to disappearance of hepatic steatosis only to recur on viral relapse.⁴ Thus it would appear that hepatic steatosis in association with hepatitis C is not simply secondary to obesity. …