Interactions between metabolic disorders [diabetes, gallstones, and dyslipidaemia] and the progression of chronic hepatitis C virus infection to cirrhosis and hepatocellular carcinoma. A cross-sectional multicentre survey

Background. Diabetes, gallstones and dyslipidaemia are widespread, metaboli cally related, disorders that can affect the liver: often in a clinically s ilent fashion. Aim. To investigate whether the presence of these disorders may worsen chro nic viral disease by inducing additional liver damage, revealed by variatio ns in serum increases of aminotransferase, alkaline phosphatase and gamma-g lutamyl-transpeptidase activities. Patients and methods. This retrospective, cross-sectional study involved 11 95 patients with chronic hepatitis C virus infection: 47.2% chronic hepatit is, 45.2% cirrhosis, and 7.6% hepatocellular carcinoma. 14.9% of patients h ad enzymatic cholestasis, defined as combined increase of alkaline phosphat ase and gamma-glutamyl-transpeptidase. A Log-linear statistical model was a pplied to the following variables: stages of liver disease, diabetes, chole lithiasis, hypertriglyceridaemia, hypercholesterolaemia, and enzymatic chol estasis. Results. Log-linear analysis, applied to categorical variables, revealed, f or the first time, a three-way interaction between the stages of chronic li ver disease, diabetes, and enzymatic cholestasis. Two-way interactions demo nstrated that liver disease stages correlated directly to the prevalence of cholelithiasis and inversely to hypercholesterolaemia. Irrespective of the liver disease stage, hypertriglyceridaemia correlated to hypercholesterola emia. Conclusions. This study discloses a synergistic liver damaging effect of di abetes and hepatitis C virus. The three-way interaction obtained by our ana lysis suggests that diabetes is a risk factor for the progression of viral liver disease and that it contributes to disease evolution, at least in par t, by induction of cholestasis.