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Concurrent Obesity, Diabetes, and Steatosis Increase Risk of Advanced Fibrosis Among HCV Patients: A Systematic Review

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Abstract

Background

Rising rates of obesity, diabetes mellitus (DM), and nonalcoholic fatty liver disease among patients with chronic hepatitis C virus infection (HCV) may contribute to more rapid disease progression.

Aim

To evaluate the impact of concurrent obesity, DM, and steatosis on disease progression among HCV patients.

Methods

A systematic review using structured keyword search of MEDLINE and EMBASE from January 1, 2001, to July 1, 2014, was performed to identify original articles evaluating the association of obesity, DM, and steatosis with advanced fibrosis (AF) among adults with chronic HCV. Studies involving HCV patients coinfected with human immunodeficiency virus, hepatitis B virus, hepatocellular carcinoma, or other chronic liver diseases were excluded. Quality assessment utilized Newcastle–Ottawa Scale.

Results

Twenty cohort studies met inclusion criteria for analyses. Obesity was associated with increased risk of AF in seven studies with effect size ranging from OR 1.08 to 7.69. However, four studies did not demonstrate a significant association between obesity and AF. The presence of advanced steatosis among HCV patients was associated with increased risk of AF in 12 studies (OR 1.80–14.3). Concurrent DM was associated with increased risk of AF in six studies (OR 2.25–9.24). Thirteen studies were good quality, and seven studies were fair quality.

Conclusion

Concurrent DM and steatosis are associated with increased risk of AF among chronic HCV patients. The majority of studies demonstrated significant associations of obesity with AF. Targeted interventions to optimize management of obesity-related diseases among HCV patients may help mitigate HCV disease progression.

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Conflict of interest

The authors of this manuscript have no conflicts of interest to disclose as described by Digestive Diseases and Sciences.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Highland Hospital, Alameda Health System – Highland Hospital Campus, Highland Care Pavilion 5th Floor, Endoscopy Unit, 1411 East 31st Street, Oakland, CA, 94602, USA

    Harleen K. Dyal, Maria Aguilar, Taft Bhuket, Benny Liu, Sharon Torres & Robert J. Wong

  2. Division of Hepatology, Department of Transplantation, California Pacific Medical Center, 2340 Clay Street, 3rd Floor, San Francisco, CA, 94115, USA

    Edward W. Holt

  3. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Stanford, CA, 94305, USA

    Ramsey Cheung

  4. Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

    Ramsey Cheung

  5. University of California, San Francisco, San Francisco, CA, USA

    Robert J. Wong

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  1. Harleen K. Dyal
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  2. Maria Aguilar
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  3. Taft Bhuket
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  8. Robert J. Wong
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Correspondence to Robert J. Wong.

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Dyal, H.K., Aguilar, M., Bhuket, T. et al. Concurrent Obesity, Diabetes, and Steatosis Increase Risk of Advanced Fibrosis Among HCV Patients: A Systematic Review. Dig Dis Sci 60, 2813–2824 (2015). https://doi.org/10.1007/s10620-015-3760-3

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  • DOI: https://doi.org/10.1007/s10620-015-3760-3

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