Clinical expression of insulin resistance in hepatitis C and B virus-related chronic hepatitis: Differences and similarities

Abstract

AIM:To investigate the prevalence of the clinical parameters of insulin resistance and diabetes in patients affected by chronic hepatitis C (CHC) or chronic hepatitis B (CHB). METHODS:We retrospectively evaluated 852 consecutive patients (726 CHC and 126 CHB) who had undergone liver biopsy. We recorded age, sex, ALT, type 2 diabetes and/or metabolic syndrome (MS), body mass index (BMI), and apparent disease duration (ADD). RESULTS:Age, ADD, BMI, prevalence of MS and diabetes in patients with mild/moderate liver fibrosis were significantly higher in CHC. However, the degree of steatosis and liver fibrosis evaluated in liver biopsies did not differ between CHC and CHB patients. At multivariate analysis, age, sex, BMI, ALT and diabetes were independent risk factors for liver fibrosis in CHC, whereas only age was related to liver fibrosis in CHB. We also evaluated the association between significant steatosis (> 30%) and age, sex, BMI, diabetes, MS and liver fibrosis. Diabetes, BMI and liver fibrosis were associated with steatosis > 30% in CHC, whereas only age and BMI were related to steatosis in CHB. CONCLUSION:These data may indicate that hepatitis C virus infection is a risk factor for insulin resistance.

Post-challenge hyperglycemia is a significant risk factor for the development of hepatocellular carcinoma in patients with chronic hepatitis C

“…It has been shown that HCV itself, including its core protein, induces insulin resistance by impairing the insulin signaling pathway [26,27]. It was also reported that insulin resistance was more severe in chronic HCV-infected patients than in patients with chronic hepatitis caused by another etiology [28,29]. However, our study failed to show any associations between HOMA-IR or fasting insulin and the development of HCC.…”

Insulin resistance in non-diabetic patients of chronic Hepatitis C

“…It is also very well known to be associated with chronic hepatitis C infection. 1 Hepatitis C is the most common cause of chronic hepatitis worldwide, which causes liver damage over a course of time. The chronic low grade inflammation in patients with chronic hepatitis C leads to persistent immune cell activation and inflammatory cytokine release causing metabolic disruption in adipose tissues.…”

The Role of Hepatic Steatosis in Chronic Hepatitis B Infection

“…In fact, three large studies involving a total of 2,245 patients demonstrated a significant inverse relationship between steatosis and severe necroinflammation and liver fibrosis on multivariate analyses, suggesting a potential protective role for steatosis in decreasing risk for advanced liver disease [32, 33•, 39]. Shi et al [33•] reported a lower risk for significant liver fibrosis (Scheuer stage ≥2) among individuals with steatosis compared to those without steatosis (39.6% vs 53.5%, P<0.05), and Persico et al [32] reported a lower risk for liver fibrosis (OR 0.459), although this was not statistically significant. These findings are in contrast to prior observations of an increased risk for major liver outcomes in patients with CHB and metabolic syndrome, suggesting that hepatic steatosis does not appear to independently contribute to worsening liver injury or HCC risk, after controlling for other metabolic factors.…”