Reuters Health Information (2005-07-07): Insulin resistance causes steatosis in HCV infection
Insulin resistance causes steatosis in HCV infection
Last Updated: 2005-07-07 12:15:12 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Insulin resistance is a
cause, not a consequence, of steatosis in patients with hepatitis C
virus (HCV), according to a new report.
Dr. L. Serfaty of Hopital Saint-Antoine in Paris and colleagues
conclude in the July issue of Gut that insulin resistance promotes
liver fibrosis by inducing steatosis among patients with non-genotype-3
HCV. "Metformin or peroxisome proliferator activated receptor gamma
agonists could be interesting therapeutic options for improving
steatosis and fibrosis in HCV infected patients with insulin
resistance," they write.
While insulin resistance, type II diabetes and steatosis and hepatic
fibrosis are more common among HCV-infected patients, the researchers
note, the relationship among these factors is not clear.
To investigate, they studied 141 patients with non-cirrhotic HCV
infection, comparing the 28 with HCV genotype 3, which is known to
promote steatosis, to those with other HCV genotypes. Non-genotype 3
patients were classified as "genotype 1," although the group included
Thirty percent of genotype 1 patients had fatty liver, defined as
steatosis affecting more than 10% of hepatocytes, while nearly 60% of
genotype 3 patients did. Genotype 1 patients with steatosis were older
and had a higher average BMI than those without fatty liver.
Insulin resistance was worse in genotype 1 patients with fatty liver
compared to genotype 3 patients with steatosis and with all patients
without fatty liver, the researchers found. Multivariate analysis
identified insulin resistance as the only factor independently
associated with steatosis in genotype 1 patients. While insulin
resistance was more common among genotype 1 patients with fibrosis, the
researchers found, the relationship was no longer significant after
they adjusted for steatosis. The only factors significantly associated
with insulin resistance in the genotype 1 patients were age and degree
Among patients with genotype 3, the only variable related to
steatosis was viral load. Steatosis also was associated with more
"Increased circulating insulin is a risk factor for fibrosis in
genotype 1 infected patients with chronic hepatitis C through insulin
resistance induced steatosis," the researchers conclude. "Accordingly,
it may be speculated that intervention strategies to reduce insulin
resistance associated with steatosis should target these patients."
In an editorial accompanying the study, Dr. A.M. Diehl and
colleagues from Duke University Medical Center in Durham, North
Carolina, say the findings underscore the importance of weight loss and
related lifestyle changes in the treatment of patients with HCV.
"Similarly, new therapeutic approaches exploiting the interaction
between HCV and lipid metabolism are eagerly awaited," they conclude.