Substantial weight gain is common after hepatitis C cure, according to an analysis of a large cohort by US Veterans Affairs researchers. Their findings, published in the Journal of General Internal Medicine, reveal that one in five people with normal body weight became overweight within two years of achieving sustained virologic response (SVR).
The Risks of Weight Gain
- Being overweight or obese increases the risk of:
- High blood pressure (hypertension).
- Cardiovascular disease.
- Type 2 diabetes.
- Certain types of cancer.
- Obesity (BMI > 30) poses a higher risk compared to being moderately overweight (BMI 25-29.9).
- Obesity also raises the risk of non-alcoholic fatty liver disease (NAFLD), which can:
- Cause liver damage.
- Reverse improvements in liver health post-hepatitis C cure.
Study Overview
- Researchers analyzed data from the US Veterans Affairs Cohort (born 1945-1965).
- Cohort included 11,469 hepatitis C patients who started direct-acting antiviral (DAA) treatment between January 2014 and June 2015.
- Two years of follow-up data post-SVR were examined.
- Weight changes were analyzed by categories:
- Underweight
- Normal weight
- Overweight
- Obese
Key Findings
- Baseline Characteristics:
- 96% male.
- 65% over 60 years old.
- 59% white, 35% black.
- 42% had alcohol use disorder, 38% had cirrhosis.
- 78% overweight or obese at treatment initiation, with 36% clinically obese.
- Weight Changes Over Two Years:
- Average weight gain negligible (+0.44 lbs/199g).
- 52% of participants gained weight.
- 19% gained at least 10 lbs (4.5 kg).
- 10% gained at least 16.5 lbs (7.5 kg).
- Shift in Weight Categories:
- 22% of normal-weight individuals became overweight.
- 16% of overweight individuals became obese.
Factors Linked to Weight Gain
- Higher Risk:
- Advanced fibrosis (FIB-4 score > 3.25): OR 1.24.
- Cirrhosis: OR 1.2.
- Baseline obesity (BMI > 35): 1.5x higher likelihood of weight gain.
- Protective Factors:
- Older age (> 65 years).
- No alcohol use.
- Probability Analysis:
- Greatest weight gain likelihood in younger patients with cirrhosis and moderate alcohol use.
- Example: 12.7% probability of gaining 10+ lbs in older, non-alcohol-consuming individuals without cirrhosis versus 34% in younger, obese, cirrhotic, moderate alcohol users.
The Unclear Causes of Weight Gain
- Possible mechanisms:
- Improved liver function leading to increased muscle mass.
- Age-related fat replacement of muscle.
- Likely contributors:
- Dietary habits.
- Lifestyle factors.
Implications and Recommendations
- Health Risks:
- 78% overweight at baseline means additional weight gain heightens obesity-related disease risks.
- Only 1% of obese participants lost enough weight to return to the normal range.
- Actionable Steps:
- Discuss weight management before initiating hepatitis C treatment.
- Encourage moderation of alcohol consumption.
- Address lifestyle and dietary habits that contribute to obesity.
Conclusion
The study underscores the need for proactive discussions around weight management during hepatitis C treatment. With weight gain posing risks to liver and overall health, integrating dietary and lifestyle interventions can help mitigate these challenges and support long-term well-being for patients.