Insulin resistance in non-diabetic patients with chronic hepatitis C: what does it mean?

Abstract

Objectives: To determine the prevalence of insulin resistance (IR) in non-diabetic patients with chronic hepatitis C, and to assess the association between IR, laboratory parameters and histological findings. Subjects and methods: Eighty-two patients had their serum analyzed for glucose, lipid profile, C-reactive protein (CRP), ferritin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), HOMA-IR, viral load and HCV genotype. Patients with HOMA-IR levels > 2.5 were considered as carriers of insulin resistance. Results: IR was observed in 27% of patients and was associated with age, waist circumference and body mass index. IR patients were more likely to have more advanced hepatic fibrosis and necroinflammatory activity, higher levels of aminotransferases and liver steatosis than patients without IR. Conclusions: Insulin resistance is often present in patients with chronic hepatitis C, and this parameter is associated with more advanced HCV-related hepatic fibrosis. Arq Bras Endocrinol Metab. 2011;55(6):412-8 Keywords Chronic hepatitis C; liver fibrosis; insulin resistance; HOMA-IR RESUMO Objetivos: Em portadores de hepatite crônica C não diabéticos, verificar a prevalência de resistência insulínica (RI) e analisar a associação desta com os parâmetros laboratoriais e histológicos. Sujeitos e métodos: Foram incluídos no estudo 82 pacientes, e amostras de sangue foram coletadas para determinação de glicose, perfil lipídico, alanina aminotransferase (ALT), aspartato aminotransferase (AST), ferritina, HOMA-IR, carga viral e genótipo do VHC. HOMA--IR superior a 2,5 foi considerado resistência insulínica. Resultados: RI foi observada em 27% dos pacientes e foi associada a idade, circunferência abdominal e índice de massa corpórea. Quando comparado a pacientes sem RI, aqueles com HOMA-IR superior a 2,5 apresentaram graus mais acentuados de fibrose hepática e atividade necroinflamatória, maiores níveis de aminotransferases e esteatose hepática mais frequente. Conclusões: É comum a presença de RI em portadores de hepatite crônica C e esta se associa com graus mais avançados de fibrose hepática induzida pelo vírus da hepatite C. Arq Bras Endocrinol Metab. 2011;55(6):412-8 Descritores

Insulin resistance and chronic hepatitis C in non-diabetic patients

“…Souza and cols. concluded that "Insulin resistance is often present in patients with chronic hepatitis C, and this parameter is associated with more advanced HCV-related hepatic fibrosis (1)." The finding in this study is concordant with the recent report by Itoh and cols.…”

High prevalence of insulin resistance among Brazilian chronic hepatitis C patients

“…In the bivariate analysis, IR was associated with age and anthropometric factors (BMI, waist circumference and weight categories); however, this association was not found in the multivariate analysis. Some studies also showed the association of age, waist circumference, and BMI to IR among HCV patients (9,10,11,13,18). IR was also associated with higher mean values of triglycerides and is most likely the result of the characteristics of the HCV replication cycle.…”

“…In Brazil, IR prevalence varies from 20 to 80% in HCV patients (9)(10)(11)(12)(13). IR was also associated with age, waist circumference, body mass index (BMI), advanced liver fibrosis (10), HCV viral load (14), higher mean degree of steatosis (15) and higher serum levels of oxidative stress (10,11). Although some studies have reported IR prevalence among HCV individuals, the number of subjects is relatively small, and only one or two HCV genotypes were included.…”

Avaliação da resistência à insulina em pacientes com hepatite C crônica não diabéticos

“…Baseados nos dados da insulinemia e a glicemia de jejum foi calculado o índice HOMA dos participantes e foi considerado resistente à insulina o paciente que apresentou HOMA ≥ 3,0, tomando como base estudos brasileiros (Mello V et al, 2006;Souza et al, 2011;Oliveira L et al, 2012).…”

“…Encontramos em nossa casuística uma frequência de 25,7% de resistência à insulina, valor muito próximo de outros estudos, como um francês e brasileiro (Moucari et al, 2008: Souza et al, 2011 (Valente et al, 2005).…”