Chronic Hepatitis C Associated with Body Composition Changes

In a new study, researchers quantified global and regional body composition changes in patients with chronic hepatitis C (CHC), and compare them with healthy controls to identify a potential association between hepatitis C and body composition changes.

The study, published in the Journal of Gastrointestinal and Liver Diseases, was the first to compare CHC patients with controls in regards to soft tissue body composition changes. To date, CHC patient body composition was mainly used to evaluate the impact on bone metabolism, while the examination of lean body mass and fat was not evaluated.

The cross-sectional study involved a cohort of 60 CHC patients who were enrolled at the National Institute for Infectious diseases from August 2015 to February 2016, along with 60 healthy control counterparts. Researchers collected relevant demographic (age, gender), anthropometric (BMI, cigarette smoking data, and disease related data from study participants.

The FibroTest was used for the non-invasive liver fibrosis assessment, while the total, regional and soft tissue composition measurements were conducted using the DXA machine, GE LUNAR DPX-NT. To determine the strength of relationship between variables from the 2 groups, researchers used Spearman’s rank correlation coefficient (rho).

Sixty CHC patients and 60 healthy controls were assessed by Dual Energy X-Ray Absorptiometry. The mean age of CHC patients was 46.1-years-old, and 25 patients (41.6%) were active smokers.

Ex-smokers consisted of 13 patients (21.6%) and 22 non-smokers (36.6%). About half of the patients had less than 5 years of disease evolution since CHC diagnosis, and approximately half of them presented detectable viral load (55%).

For fibrosis grade, half of patients were in stage F2-F3. The majority of patients had been treated with antiviral therapy.

The results of the study showed that there were no differences between CHC patients and controls regarding BMI, lean body mass, age, weight, and height. In fat body mass, researchers found a significant reduction in total fat mass (FM), trunk FM, and percent body fat (PBF) in CHC patients compared with controls. The reduced fat body mass was reflected in a higher FMR in the group of CHC patients, according to the study.

Compared with the controls, the body mineral composition (BMD) values were lower in CHC patients. There was a statistically significant decrease in total body scan, and in the scan of specific regions: hip, lumbar spine (LS), trunk, arms, and legs.

Additionally, the Z and T-scores were found to be significantly lower in patients aged 50 years and ≥ 50 years-old than in the controls at all the 3 sties. The lowest mean Z-score was seen at the LS (-0.69, p=0.0006) and the lowest mean T-score was obtained at the hip (-0.34, p=0.003).

In regards to the association between changes in soft tissue body composition and CHC, researchers found that total FM negatively correlated with the antiviral treatment in all CHC patients, with stronger correlation in the male group, the study reported.

In the CHC male group, the total FM was negatively associated with peginterferon alpha 2a and ribavirin treatment. The BMD was lower compared with controls, and correlated with low BMI, cigarette smoking, and peginterferon alpha 2a and ribavirin treatment.

The study authors stated that the most important findings from the study was the demonstration of reduced FM (total FM, trunk FM, and PBF) in CHC patients, suggesting that CHC patients may acquire troncular lipodystrophy.

Several risk factors were found to be associated with reduced FM, including cigarette smoking, low BMI, and treatment with peginterferon alpha 2a and ribavirin. There were strong negative correlations with the antiviral treatment regarding the LM, with a stronger correlation seen in males.

The BMD was lower for both the total body and specific regions compared with the controls. Additionally, it also correlated with low BMI, antiviral treatment, and cigarette smoking.

Authors noted that the impact of the factors, especially antiviral treatment on body composition, would be important for evaluating and addressing the metabolic complications early.