Insulin Resistance in Chronic Hepatitis B Patients Is Associated with Other Metabolic Abnormalities, Not HBV Infection Itself

By Liz Highleyman

It is well established that people with chronic hepatitis C virus (HCV) infection have a higher rate of insulin resistance, but this association has not been extensively studied in patients with chronic hepatitis B virus (HBV).

As reported in the January 2009 American Journal of Gastroenterology, researchers in India looked at predictors of insulin resistance in 69 chronic hepatitis B patients. Just under half (44.9%; n = 31) were overweight (body mass index [BMI] > 23) and 26.1% (n = 18) were obese (BMI > 25).

The investigators analyzed relationships between liver histology findings and anthropometric and biochemical data, including insulin resistance determined using the homeostasis model assessment (HOMA-IR) method.

To assess the influence of chronic HBV infection on insulin resistance independent of the possible confounding effects of patient sex, liver fibrosis, and body weight, they also compared fasting serum insulin, C-peptide levels, HOMA-IR, HOMA-beta (a measure of beta-cell function), and C-peptide-insulin ratios (to distinguish impaired insulin degradation from insulin hypersecretion) in 14 normal weight (BMI < 23) male chronic hepatitis B patients with stage 0 or 1 (absent or minimal) fibrosis and 50 normal weight healthy HBV negative men matched according to age, BMI, and waist circumference.

Results

49.3% of the chronic hepatitis B patients had insulin resistance.

BMI (Spearman's coefficient -0.436; P < 0.001) and serum triglyceride level (Spearman's coefficient -0.307; P = 0.010) were predictors of insulin resistance in a univariate analysis.

In a multiple linear regression analysis, only BMI remained an independent predictor of HOMA-IR score (P < 0.001).

In the subgroup analysis, chronic hepatitis B patients and HBV uninfected control subjects had comparable levels of all markers of insulin resistance, including fasting glucose, insulin, C-peptide, and HOMA-IR.

Based on these findings, the study authors concluded, "Insulin resistance in chronic HBV-infected patients is a reflection of the host metabolic profile, and chronic HBV infection is not in itself correlated with insulin resistance."

Department of Gastroenterology and Department of Pathology, G.B. Pant Hospital, New Delhi, India

1/30/09

Reference
M Kumar, A Choudhury, N Manglik, and others. Insulin resistance in chronic hepatitis B virus infection. American Journal of Gastroenterology 104(1): 76-82. January 2009. (Abstract).