Clinical Gastroenterology and Hepatology
Volume 11, Issue 12 , Pages 1661-1666.e3, December 2013
Lei Yu, Chihiro Morishima, George N. Ioannou
published online 28 May 2013.
Abstract
Background & Aims
Little is known about whether dietary cholesterol affects disease progression in patients with chronic hepatitis C virus infection.
Methods
We analyzed data from the Hepatitis C Antiviral Long-term Treatment Against Cirrhosis trial, which included patients with advanced fibrosis and compensated cirrhosis. Cholesterol intake was determined for 608 participants on the basis of responses to food frequency questionnaires, administered at baseline and 1.8 years later. We investigated whether cholesterol intake was associated with clinical progression (death, variceal bleeding, encephalopathy, ascites, peritonitis, Child–Turcotte–Pugh score ≥7, or hepatocellular carcinoma) or histologic progression of disease (an increase in Ishak fibrosis score of 2 or more points in a second liver biopsy compared with the first).
Results
After adjustments for age, sex, race, presence of cirrhosis, body mass index, treatment with peginterferon, lifetime alcohol consumption, smoking, health status, and coffee and macronutrient intake, each higher quartile of cholesterol intake was associated with a 46% increase in the risk of clinical or histologic progression (adjusted hazard ratio [AHR], 1.46; 95% confidence interval [CI], 1.13–1.87; P for the trend = .004). Compared with patients in the lowest quartile of cholesterol intake (32–152 mg/day), those in the 3rd (224–310 mg/day; AHR, 2.83; 95% CI, 1.45–5.51) and 4th quartiles (>310 mg/day; AHR, 2.74; 95% CI, 1.22–6.16) had significantly increased risk of disease progression.
Conclusions
On the basis of analysis of data from the Hepatitis C Antiviral Long-term Treatment Against Cirrhosis trial, higher dietary cholesterol intake is associated with higher risk of disease progression in HCV-infected patients with advanced fibrosis or compensated cirrhosis.
Keywords: Diet, Cholesterol, Hepatitis C, Cirrhosis
Abbreviations used in this paper: AHR, adjusted hazard ratio, BMI, body mass index, CI, confidence interval, CTP, Child–Turcotte–Pugh,FFQ, food frequency questionnaire, HALT-C, Hepatitis C Antiviral Long-term Treatment Against Cirrhosis, HCC, hepatocellular carcinoma,HCV, hepatitis C virus, MTP, microsomal triglyceride transfer protein, TLR, Toll-like receptor
This is very flawed study based on questionnaires, overlooking many important confounding factors which may influence clinical and histological progression of liver disease in patients with hepatitis C, including virological factors (genotype), nutritional factors (type of fats, micronutrient and anitoxidant intakes), host factors (e.g. type of lipoproteins, ethnicity). Most importantly, prospective studies supports a role of low serum total and LDL-cholesterol and of oxidative stress as positive independent predictive factors of poor RVR in HCV patients. Coversely, high LDL- cholesterol and total cholesterol and lower triglycerides were were associated with higher rates of SVR. There is also significant amount of experimenatal and epidemiological evidence that omega-6 fatty acids increase progression of liver fibrosis.
ReplyDeleteThis is very flawed study based on questionnaires, overlooking many important confounding factors which may influence clinical and histological progression of liver disease in patients with hepatitis C, including virological factors (genotype), nutritional factors (type of fats, micronutrient and anitoxidant intakes), host factors (e.g. type of lipoproteins, ethnicity). Most importantly, prospective studies supports a role of low serum total and LDL-cholesterol and of oxidative stress as positive independent predictive factors of poor RVR in HCV patients. Coversely, high LDL- cholesterol and total cholesterol and lower triglycerides were were associated with higher rates of SVR. There is also significant amount of experimenatal and epidemiological evidence that omega-6 fatty acids increase progression of liver fibrosis.
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