The prevalence of metabolic syndrome in veterans with chronic hepatitis C virus

[Guest guest]

The prevalence of metabolic syndrome in veterans with chronic

hepatitis C virus

DDW Los Angeles, May 21, 2006

Background: In addition to traditional predictors of poor response to

antiviral therapy for chronic hepatitis C such as viral load,

genotype, race, and advanced fibrosis, recent evidence has implicated

obesity related factors such as insulin resistance and hepatic

steatosis. The prevalence of insulin resistance and related MS in

veteran population with chronic hepatitis C has not been

systematically studied.

Methods: We performed a cross-sectional analysis of the prevalence of

the metabolic syndrome in chronic hepatitis C infection. We evaluated

38 consecutive veterans referred for evaluation of chronic hepatitis

C, who were drinking less than 20 g alcohol per day (by standard

questionnaire). We hypothesized that the metabolic syndrome (MS)

would be associated with worse hepatic histology than HCV infection

alone. We collected detailed demographic, anthropometric, serologic,

histologic and metabolic parameters in order to compare metabolic,

virologic and histologic status between subjects with and without the

MS. Insulin resistance was defined as a HOMA-R (fasting insulin

(mU/L) x fasting glucose (mmol/L)/22.5) greater than 2.5. MS was

defined by the presence of 3 or more ATP III criteria. Additional

data included determination of hs-CRP, TNF-α, IL-6, adiponectin and

leptin. Groups were compared using t-test and/or Fisher's exact

analysis.

Results: The average age, BMI, viral load, ALT and HOMA were

53.3±7.0, 28.0±6.3, 2.57x106, 59.4±38.3 and 4.7±7.4 respectively.

All but one of the patients were male. Caucasians and African

Americans comprised 71% and 18.4% of the cohort. The predominant

genotype in the cohort was Type 1 (81%). Twenty of the 38 veterans

studied met the ATP III criteria for the MS. Veterans with the MS had

higher BMI (p=0.001), HOMA-R (p=0.012), and leptin (p=0.008), while

no differences were seen (p=ns) in age, race, ALT, TNF-α, Il-6,

adiponectin, hs-CRP, viral load, or genotype. Patients with MS had

significantly higher prevalence of steatosis (p=0.001) and fibrosis

on biopsy (p=0.001).

Conclusion: Metabolic syndrome was present in 53% of veterans

referred with chronic hepatitis C. Leptin but not adiponectin was

significantly associated with the metabolic syndrome. Veterans with

metabolic syndrome have more steatosis and advanced fibrosis. The

high prevalence of metabolic syndrome may adversely impact outcomes

with antiviral therapy in veterans.