In overweight patients with chronic hepatitis C, circulating insulin is associated with hepatic fibrosis: implications for therapy

J Hepatol. 2003 Dec;39(6):1042-8. doi: 10.1016/s0168-8278(03)00463-x.


Background/aims: Host factors such as increased body mass index (BMI) and genotype-specific viral factors contribute to the development of steatosis in patients with chronic hepatitis C (HCV). We hypothesized that host metabolic factors associated with increased BMI may play a role in disease progression.

Methods: Fasting serum was collected from 160 patients with chronic HCV at the time of liver biopsy and 45 age, gender and BMI matched controls, and assessed for levels of insulin, c-peptide and leptin.

Results: Patients with viral genotype 3 had more severe steatosis (P=0.0001) and developed stages 1 and 2 fibrosis at a younger age (P<0.05) than patients with genotype 1. For both genotypes, overweight patients had significantly more steatosis and increased insulin and leptin levels. In contrast to lean patients, there was a statistically significant increase in circulating insulin levels with increasing fibrosis in overweight patients with chronic HCV (P=0.03). Following multivariate analysis, insulin was independently associated with fibrosis (P=0.046) but not inflammation (P=0.83). There was no association between serum leptin levels and stage of fibrosis.

Conclusions: Increasing circulating insulin levels may be a factor responsible for the association between BMI and fibrosis in patients with HCV, irrespective of viral genotype.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Body Mass Index
  • Fatty Liver / complications
  • Fatty Liver / metabolism
  • Fatty Liver / virology
  • Female
  • Genotype
  • Hepacivirus / genetics*
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / metabolism
  • Hepatitis C, Chronic / therapy
  • Humans
  • Insulin / blood*
  • Leptin / blood
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / metabolism
  • Liver Cirrhosis / virology
  • Male
  • Middle Aged
  • Obesity / complications*
  • Obesity / metabolism
  • Obesity / therapy


  • Insulin
  • Leptin