Patients suffering from two common liver ailments also tend to have metabolic syndrome, VCU study shows

Triple whammy makes treatment more difficult

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RICHMOND, Va. – Patients afflicted simultaneously with hepatitis C and nonalcoholic fatty liver disease – two of the leading causes of chronic liver disease – also tend to be obese and show symptoms of metabolic syndrome, a cluster of health problems that can include insulin resistance and other risk factors for heart disease and diabetes, according to a new study by researchers at Virginia Commonwealth University.

The study, published in the September issue of the American Journal of Gastroenterology, found that patients with hepatitis C were no more likely than patients with hepatitis B, cirrhosis or genetic liver conditions to suffer from nonalcoholic fatty liver disease (NAFLD), which refers to a range of conditions that resemble alcohol-induced damage to the liver but are found in people who either do not drink alcoholic beverages or drink in moderation.

But a five-year analysis of liver biopsies conducted at the VCU Medical Center liver clinics showed a significantly higher level of obesity in patients with both hepatitis C and fatty liver disease and much higher levels of other conditions associated with metabolic syndrome, including diabetes, high blood pressure and abnormal blood fats, such as elevated levels of triglycerides.

"Hepatitis C and NAFLD are widely considered to be two of the leading causes of chronic liver disease in North America.," said Dr. Arun J. Sanyal, professor of internal medicine, pharmacology and pathology and chair of the Division of Gastroenterology, Hepatology and Nutrition in VCU's School of Medicine Department of Internal Medicine. Dr. Sanyal was the lead author on the study.

"This study indicates that hepatitis C and NAFLD can co-exist in the same patient because both are common conditions," said Sanyal, who is recognized internationally for his research in the field of NAFLD and obesity. "It also indicates that NAFLD and the associated metabolic syndrome not only are associated with diabetes, high blood pressure and abnormal blood fats, but together they may increase the risk of developing cirrhosis in those who also have hepatitis C. The problem is further compounded by the fact that the presence of NAFLD makes a person less likely to respond to treatment for hepatitis C."

To determine whether hepatitis C, which is an inflammation of the liver caused by the hepatitis C virus, is specifically associated with NAFLD, Sanyal and his colleagues performed a retrospective analysis of approximately 4,000 liver biopsies performed at the VCU Medical Center liver clinics between 1996 and 2001. Of those, 69 biopsies were identified as coming from patients who had hepatitis C and NAFLD. They were compared with 75 biopsies from patients with hepatitis C only and biopsies from patients with NAFLD in conjunction with hepatitis B, cirrhosis and a form of inherited liver disease.

The analysis found no evidence for an association between hepatitis C and NAFLD. The prevalence of NAFLD in those with hepatitis C, hepatitis B, cirrhosis and inherited liver disease varied from 4.5 percent to 7 percent across the different patient groups.

However, the prevalence of obesity, as defined by a body mass index greater than or equal to 30, was significantly higher in those with both hepatitis C and NAFLD than just hepatitis C alone. In addition, those patients with both hepatitis C and NAFLD had a significantly higher prevalence of the metabolic syndrome conditions of diabetes, hypertension and elevated levels of triglycerides.

The research was supported, in part, by a grant from the National Institutes of Health. Preliminary results were presented at the annual meeting of the American College of Gastroenterology in Las Vegas in October 2001.