Diabetes
The incidence of diabetes is almost twice as high in people with hepatitis C, according to a study by Yu and colleagues.¹ The study compared the prevalence of glucose abnormalities between 683 chronic hepatitis C patients and 515 patients without hepatitis C (matched by sex and age). An oral glucose tolerance test was performed on 522 chronic hepatitis C patients and 447 in the control group without diagnosed diabetes.

The results reported found that in the group with HCV:

•    27.7% had normal glucose levels,
•    34.6% had impaired glucose tolerance and,
•    37.8% had diabetes.

In addition, the authors found that there was an increase in the prevalence of glucose abnormalities in people with chronic hepatitis C (65.8%) compared to the control group (35.3%).

The authors stated that the study results would suggest that people with chronic hepatitis C should be screened for diabetes.

The results from another study on diabetes in people with hepatitis C showed a marked increase in the rates of liver cancer in people infected with hepatitis C who also had diabetes. Researchers headed up by Bart Veldt² and Harry Janssen of the Erasmus MC University Medical Center in the Netherlands analyzed data from five large hepatology centers throughout Europe that included 541 patients (mean age 50 yo) of whom 85 had diabetes.

The percentage of people who were infected with HCV and who also had diabetes increased based on the severity of fibrosis:

•    10.5% - Ishak score 4*
•    12.5% - Ishak score 5
•    19.1% - Ishak score 6

*The scoring system for the degree of fibrosis used was the Ishak – with 0 as no fibrosis to 6 as cirrhosis.

More importantly, in a mean follow-up period of 4 years, 11 (13%) patients with diabetes developed hepatocellular carcinoma, or liver cancer, compared to only 27 (5.9%) patients in the HCV non-diabetic group. After 5 years, the incidence of liver cancer was 11.4% in the diabetic group compared to 5.0% in the non-diabetic group.

The authors concluded that “in patients with chronic hepatitis C and advanced cirrhosis, diabetes mellitus increases the risk of developing HCC.”

Diet
Although the two studies listed below do not specifically address hepatitis C, they do deal with issues related to metabolic disorders which are important factors in maintaining overall health, and specifically influence HCV disease progression and management as well as HCV treatment outcome. The last study specifically addresses the affect of diet on HCV disease progression and treatment outcome.

The first study, by Sahi et al.,³ compared the safety and effectiveness of various diets. The trial included 322 moderately obese people who followed the Mediterranean (restricted calories), low fat (restricted calories) and the low-carbohydrate (non-restricted calories) over a period of 2 years. The mean weight loss by diet was:

Mediterranean-diet group: 4.4 kg (9.68 lbs),
Low-Fat diet group: 2.9 kg (6.38 lbs)
Low-carbohydrate group: 4.7 kg (10.34 lbs)

Of the 272 people who were able to complete the study, the mean weight loss by diet was:

Mediterranean-diet group: 4.6 kg (10.12 lbs),
Low-fat diet group: 3.3 kg (7.26 lbs),
Low-carbohydrate diet group: 5.5 kg (12.1 lbs)

The authors concluded that the low-carbohydrate diet was favorable for lowering lipids (fats) and the Mediterranean-diet was more favorable towards glycemic (blood sugar) control and they suggested that “personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions.”

The second study, by Sofi et al.,⁴ reviewed 12 studies that included a total of 1,574,299 patients to evaluate the association between adherence to a Mediterranean diet, death and incidence of disease. The participants were followed for a time period ranging from 3 to 18 years from 1966 to June 30, 2008. On a nine-point scale, the authors found that a two-point increase in adherence to the Mediterranean-like diet was associated with a significant reduction in:

Overall death (9%)
Cardiovascular diseases (9%)
Death from cancer (6%)
The incidence of Alzheimer’s or Parkinson’s disease (13%)

The authors concluded that “[These] results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.”

The Mediterranean diet in this study varied but was generally a diet rich in legumes, cereals, fruits/nuts, vegetables, fish, olive oil, and low in the consumption of meat, meat products, dairy products, and alcohol.

Can we take the information from the two general studies and apply the outcomes to people with hepatitis C? That’s exactly what researchers Loguercio, C et. al⁵ in Italy attempted to answer in a prospective clinical trial of over 1,084 patients with chronic hepatitis C (432 treated with interferon/ribavirin) and 2,326 people without hepatitis C (control group). The participants’ dietary and alcohol consumption was evaluated with a questionnaire. Body mass index was measured and various laboratory tests, including blood glucose, cholesterol, triglycerides, nitrogen, and creatinine as well as routine liver function tests, were done. All of the study subjects were well-matched for weight (50% overweight), alcohol consumption (60% consumed alcohol), and dietary habits. The results found that “alcohol intake differed significantly between treatment responders and non-responders to interferon therapy,” and that “dietary composition was related to the extent of liver damage.” The authors commented that, “This suggests that HCV patients may benefit from instructions regarding their diet.”

References
¹Yu, et al. Reappraisal of the Characteristics of Glucose Abnormalities in Patients With Chronic Hepatitis C Infection. Am J Gastroenterol 2008;103:1933–1940

²Veldt, et al. Increased risk of hepatocellular carcinoma among patients with hepatitis C cirrhosis and diabetes mellitus. Hepatology 2008;47:1856-1862 DOI: 10.1002/hep.22251.

³Shai, et al. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. N Engl Med 2008;359:229-41

⁴ Sofi, et al. Adherence to Mediterranean diet and health status: meta-analysis. BMJ 2008;337:a1344 doi:10.ll36/bmj.a1344

⁵ C Loguercio, A Federico, M Masarone, and others. The impact of diet on liver fibrosis and on response to interferon therapy in patients with HCV-related chronic hepatitis. American Journal of Gastroenterology. September 11, 2008 [Epub ahead of print].

http://www.hcvadvocate.org/news/newsLetter/2008/advocate1008.html#5