Effect of weight reduction on liver histology and biochemistry in patients with chronic hepatitis C

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Gut 2002;51:89-94

© 2002 by Gut

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LIVER AND BILIARY DISEASE

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 and E E 7

1 Department of Nutrition and Operational Support Services, Princess

andra Hospital, Brisbane, Australia.

2 Department of Pathology, University of Queensland, Brisbane,

Australia.

3 Department of Medicine, University of Queensland, and the

Population and Clinical Sciences Division, Queensland Institute of

Medical Research, Brisbane, Australia.

4 Population and Clinical Sciences Division, Queensland Institute of

Medical Research, Brisbane, Australia.

5 Department of Endocrinology, Princess andra Hospital, Brisbane,

Australia.

6 Department of Surgery, University of Queensland, Brisbane,

Australia.

7 Department of Surgery, University of Queensland, and Department of

Gastroenterology and Hepatology, Princess andra Hospital,

Brisbane, Australia.

Correspondence to:

Dr E E , Princess andra Hospital, Ipswich Rd,

Woolloongabba, Brisbane, Queensland 4102, Australia;

_@...

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.

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Keywords: fatty liver; calorie restriction; fibrosis; stellate cells;

weight loss

Abbreviations: HCV, hepatitis C virus; BMI, body mass index; ALT,

alanine aminotransferase; -SMA, -smooth muscle actin; HOMA,

homeostasis model of assessment

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