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

Department of Nutrition and Operational Support Services, Princess Alexandra Hospital, Brisbane, Australia.
Gut (Impact Factor: 14.66). 07/2002; 51(1):89-94. DOI: 10.1136/gut.51.1.89
Source: PubMed


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.
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.
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).
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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    • "According to the knowledge accumulated so far, the only way to obtain an increase in the rates of SVR in these patients may be to advise weight loss before starting antiviral treatment [81]. As shown in patients without concomitant viral hepatic infections, only exercise ensures both fat deposit and liver enzyme decreases. "
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    • "On the contrary, a recent large study showed that there is no significant effect of BMI on the treatment outcome [139]. However, weight loss plays an important role in HCV treatment because it down regulates liver enzymes and the progression of fibrosis [140]. "
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    • "In overweight/obese patients with steatosis who subsequently lost weight, liver-related abnormalities improved [33]. Although weight loss may be difficult to achieve and sustain, the patients who did manage to lose weight showed a reduction in steatosis and abnormal liver enzymes as well as improvement in liver fibrosis, despite the persistence of the virus [34]. "
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