By Liz Highleyman

A growing body of evidence indicates that liver steatosis (fat accumulation) is associated with the metabolic syndrome, characterized by abnormal blood lipid levels, type 2 diabetes, obesity, and high blood pressure.

Research has shown that presence of liver steatosis according to biopsy is a risk factor for the development of hepatocellular carcinoma (HCC) in chronic hepatitis C patients with cirrhosis, but it is unclear whether the specific clinical correlates of the metabolic syndrome play a role.

As reported at the Digestive Disease Week (DDW 2009) annual meeting last week in Chicago, Bhavna Malik and colleagues sought to determine whether the presence of clinical risk factors for non-alcoholic fatty liver disease (NAFLD) -- i.e., obesity, type 2 diabetes, hypertriglyceridemia (elevated triglycerides), and hypertension (high blood pressure) -- in people with hepatitis C increases the risk of progression to HCC.

The investigators conducted a retrospective chart review that included 76 case patients with hepatitis C who received liver transplants at a single institution between 2000 and 2008 and had biopsy confirmed HCC. These patients were matched 1:1 on the basis of age and sex with a cohort of control hepatitis C patients without HCC who received transplants during the same period. Most participants (about 80%) were men and the mean age was 55 years.

The researchers compared the percentage of patients in the 2 groups with body mass index (BMI) greater than 30, triglyceride level above 150 mg/dL, blood glucose level above 100 mg/dL, and blood pressure above 130/85.

Results

Rates of obesity were the same in the groups with and without HCC, at 33%.

Fewer patients with HCC had diabetes compared to those without HCC (22% vs 33%).

Patients with HCC had a higher rate of hypertension (22%) compared with the control group (13%).

The HCC group also had a higher rate of hypertriglyceridemia (28%) compared with the controls (12%).

The mean triglyceride level for the patients with HCC was 127.64 mg/dL versus 100.11 mg/dL -- barely above the cut-off -- for those without HCC (P < 0.05).

"In this case control study, patients with HCV and HCC had higher rates of hypertension and hypertriglyceridemia than patients with HCV alone," the researchers concluded. "Other factors of the metabolic syndrome were not seen more commonly in patients with HCC."

"Further research is needed to determine the impact of hypertension and hypertriglyceridemia on patients with HCV and their risk of progression to HCC," they added.

In a related study presented at the recent 44th Annual Meeting of the European Association for the Study of the Liver (EASL 2009), researchers reported that metabolic syndrome was associated with a higher overall mortality rate and a higher risk of liver-related death in chronic hepatitis C patients.

Internal Medicine, South of Market Health Center, San Francisco, CA; GI/Hepatology, California Pacific Medical Center, San Francisco, CA.

6/9/09

Reference
B Malik and C Frenette. Metabolic Syndrome and Risk for Progression to Hepatocellular Carcinoma in Patients with Hepatitis C Cirrhosis. Digestive Disease Week (DDW 2009). Chicago. May 30-June 4, 2009. Abstract M1775.