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The prevalence of metabolic syndrome (53%) in veterans with chronic hepatitis C virus
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DDW Los Angeles, May 21, 2006
P. K. Pandya1, 2; S. C. Mathur3; P. Callahan1; P. Shah4; D. Reker5
1. Gastroenterology and Hepatology, Kansas City VA medical center, Kansas CIty, MO, USA.
2. Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA.
3. Pathology, Kansas City VA medical center, Kansas CIty, MO, USA.
4. University of Missouri Kansas City School of Medicine, Kansas CIty, MO, USA.
5. Research, Kansas City VA Medical Center, Kansas City, MO, USA.
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-a, 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-a, 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.
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