Fatty Liver, Cardiometabolic Risk Factors Common Among Adults With HCV

Hsu-Huei Weng, MD, PhD, MPH

Credit: ResearchGate

Findings from a recent study are highlighting an increased prevalence of fatty liver in rural adults with chronic hepatitis C virus (HCV), calling attention to the need for antiviral therapy combined with weight loss management and lifestyle modification to improve patients’ liver and cardiometabolic health.¹

Results from the series of cohort studies in Taiwan revealed having chronic HCV and moderate to severe fatty liver was significantly associated with central obesity, elevated blood pressure, metabolic syndrome, and elevated liver enzyme levels, suggesting the importance of fatty liver screening alongside treatment with direct-acting antivirals (DAAs).¹

According to the World Health Organization, HCV often goes undiagnosed in its early stages until symptoms develop secondary to serious liver damage, including fibrosis, cirrhosis, and even liver failure. Metabolic conditions associated with obesity, high blood sugar, and high blood lipids can cause excess fat storage in the liver and subsequent inflammation, also associated with HCV. Early detection of liver damage is the best way to ensure prompt treatment and improved outcomes, so understanding the connection between liver disease and HCV is critical for improving patient outcomes.^2,3

To explore the prevalence of fatty liver and its association with metabolic syndrome in patients with chronic HCV, Hsu-Huei Weng, MD, PhD, MPH, professor and director at Chang Gung Memorial Hospital in Taiwan, and a team of investigators conducted a series of cohort studies in Yunlin County, Taiwan, between August 2018 and July 2021, inviting rural adults who were anti-HCV-positive during specific community liver health screening for further HCV RNA confirmation. For inclusion, patients were required to be fully independent in daily activity and able to walk to their local hospital, > 20 years of age, and able to communicate in Mandarin or Taiwanese. Those who reported alcohol consumption or had hepatitis B virus coinfection were excluded from the study.¹

Fatty liver was assessed by a gastrointestinal physician or radiologist using ultrasonography and classified into 4 grades: normal (grade 0), mild (grade 1), moderate (grade 2), and severe (grade 3). Investigators also examined serum glutamic-oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), and gamma-glutamyl transferase (GGT) as liver enzyme biomarkers. Additionally, metabolic syndrome was defined based on the presence of ≥ 3 of 5 abnormal biomarkers, including increased waist circumference, elevated blood pressure, elevated fasting blood glucose level, elevated triglyceride level, and low high-density lipoprotein cholesterol (HDL-C) level.¹

In total, 256 adults with chronic HCV were included in the analysis. Among the cohort, 66% of patients were female and the mean age was 67.5 (standard deviation [SD], 11.8) years. Investigators observed a high prevalence of fatty liver (79%), central obesity (54.3%), elevated blood pressure (55.5%), elevated fasting blood glucose (44.9%), and metabolic syndrome (37.9%).¹

Mild fatty liver (39%) was most common, followed by moderate (35%) and severe (5%) fatty liver. Compared to participants with no or with mild fatty liver, those with moderate to severe fatty liver had higher average BMI (P < .001), waist circumference (P <.001), systolic blood pressure (P <.05), diastolic blood pressure (P <.001), triglyceride level (P <.05), and lower HDL-C level (P <.05). Those with moderate or severe fatty liver also had more abnormal metabolic syndrome components and an overall greater prevalence of metabolic syndrome than those with no or mild fatty liver (P <.001).¹

Further analysis revealed moderate to severe fatty liver was significantly associated with increased waist circumference (Odds ratio [OR], 2.71; 95% CI, 1.59-4.64), elevated blood pressure (OR, 2.08; 95% CI, 1.21-3.58), and lower HDL-C level (OR, 1.94; 95% CI, 1.16-3.24). Investigators noted overall, moderate to severe fatty liver was significantly associated with the diagnosis of metabolic syndrome (OR, 2.86; 95% CI, 1.66-4.92).¹

“This study highlights that clinicians and primary healthcare providers should encourage patients with CHC to undergo fatty liver screening in addition to DAAs treatment and to improve their general liver and cardiometabolic health through weight loss management and lifestyle modifications,” investigators concluded.¹

References:

1. ^{Wang TJ, Chen MY, Lin YC, et al. High prevalence of fatty liver and its association with metabolic syndrome among rural adults with chronic hepatitis C: Implications for primary healthcare. BMC Public Health 24, 532 (2024). https://doi.org/10.1186/s12889-024-17851-0}
2. ^{World Health Organization. Hepatitis C. Newsroom. July 18, 2023. Accessed February 27, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c}
3. ^{Cleveland Clinic. Liver Disease. Diseases & Conditions. October 4, 2023. Accessed February 27, 2024. https://my.clevelandclinic.org/health/diseases/17179-liver-disease}