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The impact of obesity and liver steatosis on the rate of liver fibrosis among patients with chronic hepatitis C

W. Kryczka, M. Chrapek, K. Paluch, D. Zarębska-Michaluk, A. Urbaniak

Med Sci Monit 2003; 9(2): 9-

ID: 15235

Published: 2003-05-20

Background:To study the potential predictive role of obesity and liver steatosis (LS)on the rate of liver fibrosis (RLF)among patients with chronic hepatitis C (CHC).Material/Methods:354 consecutive,biopsy proven (assessed according to Ishak ’s criteria)patients (mean age at biopsy: 42 ±14 years;F/M:178/176)with untreated CHC and known probable duration of HCV infection were seen.Subject with other forms of liver disease as well as heavy drinkers were excluded from analysis.The RLF was defined as the ratio between fibrosis stage (scored 0 –6 units with 6 representing cirrhosis)and the duration of infection (in years). Based on published data,a patient with RLF>/=0,3 (cirrhosis up to 20 years after HCV infection)was considered as rapid progressor. The obesity was defined as body mass index >30 kg/m 2 .In our analysis,the LS was graded as 0,1,2 respectively to less than 1% (or absence),1 –10%and more than 10%hepatocytes involved. Results: Overall, 15% (54/354)patients were rapid progressors. 13%(46/354)patients were obese and the grade 0,1 and 2 of LS was observed in 58% (201/354), 34%(121/354) and 9% (32/354)of patients, respectively.The rapid progressors were significantly more frequently noted among obese than among non-obese patients (30%vs.13%;p=0,004)as well as among patients with increasing LS (12%,17%and 28%rapid progressors,respectively among patients with grade 0,1 and 2 of LS; p=0.04).In logistic regression analysis,after adjusting for age at biopsy and sex,only obesity (adjusted OR=2,2; 95%CI [1.1 –4.7 ];p=0.03)and not LS (p=0.21)was an independent predictor of rapid progression to cirrhosis.Conclusions:Our study confirmed recently published findings indicating that obesity maybe considered as a predictor of rapid disease progression in CHC patients.It suggests that weight reduction may play a significant role in hepatitis C management and constitute an alternative,especially among non-responders or patients with contraindications to interferon therapy