Association of Obesity, Diabetes, and Alcohol Use With Liver Fibrosis Among US Adults With Hepatitis C Virus Infection

Abstract

HIV infection, obesity, and diabetes are associated with advanced stages of fibrosis in HCV. [1][2][3][4][5] However, these risk factors are likely interdependent and potentially exacerbated by other conditions that may contribute to liver fibrosis. 6 Identifying patients with HCV who are at risk for advanced fibrosis is important for evidence-based, efficient HCC screening practices. We therefore examined the association of HCV, obesity, diabetes, and alcohol use with liver fibrosis by using electronic health records (EHRs) from a large database of patients with HCV seen at a safety-net hospital in Atlanta, Georgia. MethodsThis cross-sectional study was approved by the Emory University Institutional Review Board.Informed consent was waived because the research involved no more than minimal risk, the research could not practicably be carried out without the requested waiver or alteration, and the waiver would not adversely affect the rights and welfare of the subjects. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.We conducted a retrospective, cross-sectional analysis of treatment-naive adults with HCV seen at Grady Memorial Hospital Liver Clinic in Atlanta, Georgia, who had index ultrasound elastography studies performed between January 1, 2018, and December 31, 2019. All data within approximately 12 months of ultrasound elastography were ascertained from EHRs. Continuous data are presented as the mean (SD) or median (IQR), and categorical data are presented as frequency distributions. To compare continuous variables, we conducted F tests or nonparametric tests for variables with nonnormal distributions and χ 2 tests for categorical variables. Data were stratified by diabetes and obesity (body mass index > 30, calculated as weight in kilograms divided by height in meters squared). The outcome variables of interest were fibrosis severity (F0/F1 to F4 stage) and steatosis severity (S0 to S3 stage). Because racial differences have been noted in liver-related outcomes such as steatosis and fibrosis, we gathered self-reported race and ethnicity data from the EHR. To explore effect modification, we investigated whether the association of diabetes with fibrosis and steatosis differed according to alcohol use, adding a multiplicative interaction term between diabetes status and alcohol use. Additional details are provided in the eMethods in the Supplement. ResultsWe identified 965 patients who underwent ultrasound elastography. Five patients were excluded because of missing data, resulting in a final sample of 960 patients with a mean (SD) age of 58.3 (10.2) years. Of these 960 patients, 632 (65.8%) were men, 761 (79.3%) were Black, 247 (25.7%) had obesity, 231 (24.0%) had diabetes, and 260 (27.1%) had a history of alcohol use. Overall fibrosis

Investigating the causal association between obesity and risk of hepatocellular carcinoma and underlying mechanisms

“…Simultaneously, we observed that differential gene expression also affects the regulation of viral transcription. Migdal et al 42 similarly found that obesity can accelerate the progression of liver fibrosis in patients with hepatitis C virus infection. Previous studies have also confirmed that the risk of HCC significantly escalates when hepatitis C virus infection patients concurrently experience alcoholism or obesity, with the odds ratio increasing from 8–12 to 48–54 43 – 45 .…”

Impact of Direct-Acting Antiviral Therapy on Liver Fibrosis Regression among People with Chronic HCV Infection: Results from a Real-Life Cohort in Patients Who Achieved Sustained Virological Response

“…It is estimated that progression to cirrhosis is 16% at 20 years and 41% at 30 years [6,7]. In addition, HCV complications (i.e., ascites, encephalopathy), diabetes mellitus, obesity, and high active alcohol use are associated with advanced fibrotic stages [8]. The most relevant complication is hepatocellular carcinoma, whose annual incidence is close to 3% [9].…”