Chronic hepatitis C and superimposed nonalcoholic fatty liver disease

Background/Aims: Hepatitis C and nonalcoholic fatty liver disease (NAFL) ar e the two most common forms of liver disease in the United States. Recently , obesity and its associated risk factors have been suggested to enhance HC V-related fibrosis. The aim of this study was to assess the impact of hepat ic steatosis, steatohepatitis, and its associated risk factors on HCV-relat ed fibrosis. Methods: Patients with untreated, biopsy-proven, chronic hepat itis C (6/97-3/99) were included. Clinical and demographic data at the time of liver biopsy were obtained from chart review and verified by telephone survey. One hepatopathologist reviewed all pathologic specimens, using the modified histological activity index score and the Ishak staging for fibros is and a NAFL pathologic, protocol. Results: One hundred and seventy patien ts with hepatitis C were included [age: 48.7 +/- 9.33 (years), body mass in dex (BMI): 28.1 +/- 5.7 (kg/m(2)) and type 2 diabetes mellitus (DM): 14%]. Of these, 77 (45.3%) had no or mild fibrosis and 93 (54.7%) had advanced fi brosis. Hepatic steatosis, was seen in 90 (52.9%) patients. The grade of st eatosis was associated with markers of obesity only. Age (p=0.002), type 2 DM (p=0.04), and superimposed steatohepatitis (p=0.047) were independently associated with advanced fibrosis. Superimposed nonalcoholic steatohepatiti s (NASH) was seen in 17 (10%) patients. Patients with superimposed NASH wer e mostly obese (76.5%), mates (62%) with 16% having type 2 diabetes and a B MI 33.8+/-7.12. Conclusion: In patients with chronic hepatitis C, type 2 DM and superimposed steatohepatitis are independently associated with advance d fibrosis.