Lifestyle changes can have big health benefits for overweight people with HCV

A low-fat or low-calorie diet combined with moderate physical activity has tangible health benefits for people with hepatitis C virus (HCV) who are overweight, research published in Nutrition Journal shows. The study participants lost weight, experienced improvements in their insulin and lipid profiles and the prevalence and severity of fatty liver disease (steatosis) fell significantly.

“This study demonstrated that lifestyle changes…improved the anthropometric parameters, glucose parameters and lipid and liver profiles,” comment the authors. “Further improvements was noted in the results of non-invasive liver fibrosis testing, as well as improvement in the prevalence and severity of hepatic steatosis.”

Obesity in people with HCV is associated with metabolic complications, type-2 diabetes, fatty liver disease and the progression of fibrosis.

Investigators in Bucharest, Romania, therefore wanted to see if a structured programme of lifestyle changes incorporating a low-fat or low-calorie diet and moderate physical activity had an impact on body weight, insulin resistance, lipid levels and liver function.

They designed a prospective study involving 120 people who received care between 2007 and 2010. All the patients were aged 35 or over, had chronic HCV infection and were overweight or obese. Patients with HIV co-infection were excluded from participation.

The participants received nutritional counselling and were randomised to adopt either a low-calorie diet or a low-fat diet. Counselling was also provided regarding physical activity, and the participants were recommended to take moderate exercise in sessions lasting 30 minutes at least three times a week.

Baseline assessments included weight, insulin resistance, blood lipids, steatosis and fibrosis. These assessments were repeated after six and twelve months.

Between 40 and 45% of participants were classified as obese on entry to the study and all had sedentary lifestyles.

After twelve months, weight loss averaged 4kg for people on the low-calorie diet and 3kg for people on the low-fat diet, a non-significant difference.

Physical activity peaked during the first six months of the study and then declined. However, at the twelve-month assessment, the study participants had significantly higher levels of physical activity compared to baseline.

Insulin resistance improved by 32% in the low-calorie group (p = 0.026) and by 26% in people on the low-fat diet (p = 0.03).

Liver function also improved with both diets.

Fatty liver disease was present in between 46 and 56% of participants at baseline. Both diets were associated with improvements in the prevalence and severity of steatosis (p < 0.001).

Almost two-thirds of participants (62%) had metabolic syndrome at the start of the study. By month twelve, all parameters associated with metabolic syndrome had improved in both groups (p < 0.005). At the end of the study, only 26% of people on the low-calorie diet and 27% of people on the low-fat diet showed signs of metabolic syndrome.

“In CHC [chronic hepatitis C] patients lifestyle changes through medical nutritional therapy and physical activity led to an improvement in all metabolic parameters: reduced insulin resistance, lower blood pressure, lower triglycerides, total serum cholesterol, LDL-C, increased HDL-C, reducing systolic and diastolic blood pressure,” write the authors. “Changes in food intake were sustainable, associated with long-term metabolic benefits.”

They conclude: “Overweight or obese patients with hepatitis C undergoing a lifestyle intervention (specific dietary intervention and physical activity) for 1-year had significant improvements in body weight, lipid and hepatic profiles.”