The Impact of Diet on Liver Fibrosis and on Response to Interferon Therapy in Patients With HCV-Related Chronic Hepatitis

Carmela Loguercio, MD; Alessandro Federico, MD; Mario Masarone, MD; Roberto Torella, MD; Marcello Persico, MD


Am J Gastroenterol. 2008;103(12):3159-3166. 

In This Article

Abstract and Introduction


Background and Aims: A deranged metabolic status and alcohol intake may trigger induction and progression of chronic hepatitis C virus (HCV) liver disease. The aim of this study was to evaluate whether dietary composition affects the severity of liver damage and response to therapy in patients with HCV-related chronic hepatitis.
Methods: We enrolled 1,084 patients with biopsy-proven HCV-related chronic hepatitis (432 treated with interferon plus ribavirin) and 2,326 healthy subjects in this prospective study conducted in a university hospital. Dietary habits were recorded in enrolled individuals, and their alcohol consumption was evaluated with a questionnaire (AUDIT). Body mass index, and plasma levels of blood glucose, nitrogen, creatinine, cholesterol, and triglycerides were also measured. All individuals underwent routine liver tests and HCV genotyping.
Results: At study onset, there were no differences in metabolic status or alcohol consumption between patients and controls. About 50% of each group was overweight, and about 60% consumed alcohol. Patients and controls had similar dietary habits. Intake of carbohydrates, lipids and polyunsaturated fatty acids, and alcohol consumption were independent factors of liver damage at histology (logistic regression analysis). Some dietary components (unsaturated fatty acids, iron, zinc, vitamin A, and niacin) and alcohol intake differed significantly (P < 0.05 and P 0.01, respectively; univariate analysis) between responders and nonresponders to interferon therapy. Genotype, age, body mass index, steatosis, and fibrosis were independent predictors of therapy outcome (P < 0.02; multivariate analysis).
Conclusions: The severity of HCV-related chronic hepatitis depends on a variety of factors. Our results show that dietary composition is related to the extent of liver damage. Although traditional risk factors independently affected treatment response, some dietary components were associated with nonresponse to therapy in our patients. This suggests that HCV patients may benefit from instructions regarding their diet.


Viral and host factors regulate the progression of chronic hepatitis and the response to therapy in patients with HCV-related chronic hepatitis, which has been termed a metabolic disease.[1,2,3,4,5,6] Recent years have seen a surge of interest in complementary food and chemopreventers to treat various liver diseases including cirrhosis.[7,8,9,10,11,12,13] Diet influences body mass index (BMI), iron content in the liver, insulin, enzyme activities, substrate reserves, and metabolic pathways in hepatocytes, and many foods have been reported to exert protective or toxic effects on the liver in animal models and humans.[14,15,16,17,18,19,20] Moreover, imbalanced diets were found to affect the development and progression in a group of patients with nonalcoholic steatohepatitis.[21] However, to our knowledge, there are no data about the relationships between diet and liver damage in patients with HCV-related chronic hepatitis.

We undertook the present prospective study to evaluate the effect of diet on the severity of liver damage and on the response to antiviral therapy in patients with HCV-related chronic hepatitis.


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