Racial Differences Seen In Steatosis In Patients With Hepatitis C
07 Jan 2007
Caucasian patients with chronic hepatitis C virus (HCV) are more likely to
have hepatic steatosis, or fat in the liver, compared to African-American
patients. However, steatosis is not associated with HCV treatment response.
These findings are published in the January 2007 issue of Hepatology, the
official journal of the American Association for the Study of Liver Diseases
(AASLD). Published by John Wiley & Sons, Inc., the journal is available
online via Wiley InterScience.
Hepatic steatosis is common among patients with HCV and often indicates more
advanced disease. Researchers, led by Hari Conjeevaram, M.D., M.S. Division
of Gastroenterology at the University of Michigan at Ann Arbor, sought to
investigate racial differences in the prevalence and severity of hepatic
steatosis in patients with HCV, genotype 1. Additionally, they investigated
the relationship between steatosis and body characteristics and other
measures of insulin resistance. "We also wanted to assess whether the
presence and severity of hepatic steatosis and/or insulin resistance were
important factors to predict virological response in this population," the
The researchers studied 194 African-American and 205 Caucasian patients with
HCV, genotype 1. All patients were participating in a multi-center
prospective study of peginterferon and ribavirin therapy. The researchers
compared the prevalence and severity of steatosis and steatohepatitis to
demographic, lifestyle and clinical characteristics. They also investigated
relationships between sustained virological response and both steatosis and
The researchers found hepatic steatosis in 61 percent of the
African-American patients and 65 percent of Caucasian patients. In a
univariable analysis, the steatosis was associated with HOMA-IR (a measure
of insulin resistance), body mass index, waist circumference, serum
triglycerides, aminotransferase levels, and histological scores for
inflammation and fibrosis. After adjusting for those features, they found
that African-Americans had a dramatically lower risk of steatosis. For a
given degree of overweight and obesity or insulin resistance,
African-Americans were approximately half as likely to have hepatic
steatosis. After examining patient characteristics and their responsiveness
to treatment, the authors report, "insulin resistance and fibrosis are
important and obesity and steatosis may be less or not as important."
The results may have been confounded by patients taking oral anti-diabetic
agents, and by the possibility that HOMA underestimated the degree of
insulin resistance in overtly diabetic patients.
Still, "the importance of these findings is that insulin resistance is a
potentially modifiable factor, so that responses to antiviral therapy in
hepatitis C may be improved by modulation of insulin signaling and
improvements in insulin resistance and glucose control. These possibilities
deserve prospective evaluation," they conclude.
This work was funded by grants from the National Institute of Diabetes and
Digestive and Kidney Diseases, National Institutes of Health.
Article: "Race, Insulin Resistance and Hepatic Steatosis in Chronic
Hepatitis C," Hari S. Conjeevaram, David E. Kleiner, Jay E. Everhart, Jay H.
Hoofnagle, Steven Zacks, Nezam H. Afdhal, and Abdus S. Wahed for the Virahep-C
Study Group, Hepatology; January 2007 (DOI: 10.1002/hep.21455).